Provider Demographics
NPI:1316195977
Name:COLUMBUS PSR/PEER CENTER
Entity Type:Organization
Organization Name:COLUMBUS PSR/PEER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIDDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-638-0350
Mailing Address - Street 1:9067 VETERANS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901
Mailing Address - Country:US
Mailing Address - Phone:706-641-9663
Mailing Address - Fax:706-494-7072
Practice Address - Street 1:9067 VETERANS PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901
Practice Address - Country:US
Practice Address - Phone:706-641-9663
Practice Address - Fax:706-494-7072
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICANWORK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-08
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty