Provider Demographics
NPI:1083991806
Name:FUTURE VISION OF SOUTHWEST GEORGIA
Entity Type:Organization
Organization Name:FUTURE VISION OF SOUTHWEST GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-671-0507
Mailing Address - Street 1:601 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-1729
Mailing Address - Country:US
Mailing Address - Phone:336-671-0507
Mailing Address - Fax:
Practice Address - Street 1:601 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1729
Practice Address - Country:US
Practice Address - Phone:336-671-0507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FUTURE VISION/VISION HOUSE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty