Provider Demographics
NPI:1235314535
Name:KINGDOM OF GOD CHRISTIAN CENTER INC
Entity Type:Organization
Organization Name:KINGDOM OF GOD CHRISTIAN CENTER INC
Other - Org Name:KOGCC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:ALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:LAPC
Authorized Official - Phone:706-689-0209
Mailing Address - Street 1:1684 BREEDS HILL LOOP
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6737
Mailing Address - Country:US
Mailing Address - Phone:706-689-0209
Mailing Address - Fax:706-689-0209
Practice Address - Street 1:1684 BREEDS HILL LOOP
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-6737
Practice Address - Country:US
Practice Address - Phone:706-689-0209
Practice Address - Fax:706-689-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health