Provider Demographics
NPI:1043884927
Name:CENTER FOR WELLNESS AND RECOVERY OF NORTHEAST GA CORPORATION
Entity Type:Organization
Organization Name:CENTER FOR WELLNESS AND RECOVERY OF NORTHEAST GA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-886-4673
Mailing Address - Street 1:467 W DOYLE ST
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-1791
Mailing Address - Country:US
Mailing Address - Phone:706-886-4673
Mailing Address - Fax:706-381-3100
Practice Address - Street 1:467 W DOYLE ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-1791
Practice Address - Country:US
Practice Address - Phone:706-886-4673
Practice Address - Fax:706-381-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility