Provider Demographics
NPI:1205209608
Name:GOOD SAMARITAN CLINIC OF WASHINGTON COUNTY INC.
Entity Type:Organization
Organization Name:GOOD SAMARITAN CLINIC OF WASHINGTON COUNTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-347-3034
Mailing Address - Street 1:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-0231
Mailing Address - Country:US
Mailing Address - Phone:770-672-6400
Mailing Address - Fax:
Practice Address - Street 1:2524 E ALEXANDER ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3330
Practice Address - Country:US
Practice Address - Phone:662-347-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health