Provider Demographics
NPI:1073908786
Name:GEORGIA DETOX AND RECOVERY, LLC
Entity Type:Organization
Organization Name:GEORGIA DETOX AND RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MBA
Authorized Official - Phone:470-440-1647
Mailing Address - Street 1:2300 WINDY RIDGE PARKWAY
Mailing Address - Street 2:SUITE 210S
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:470-440-1647
Mailing Address - Fax:561-697-4345
Practice Address - Street 1:230 BRIARCLIFF RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3404
Practice Address - Country:US
Practice Address - Phone:561-868-1607
Practice Address - Fax:561-697-4345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERMEND HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-31
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029-2540-D324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility