Provider Demographics
NPI:1215188073
Name:MIDDLE GEORGIA BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:MIDDLE GEORGIA BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MORRLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-4845
Mailing Address - Street 1:402 W MADISON ST
Mailing Address - Street 2:PO BOX 635
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5232
Mailing Address - Country:US
Mailing Address - Phone:478-275-4845
Mailing Address - Fax:478-277-9192
Practice Address - Street 1:402 W MADISON ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5232
Practice Address - Country:US
Practice Address - Phone:478-275-4845
Practice Address - Fax:478-277-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA845236863BMedicaid
GA845236863AMedicaid