Provider Demographics
NPI:1326428467
Name:PAUL ANDERSON FAMILY STRONG CENTER, INC.
Entity Type:Organization
Organization Name:PAUL ANDERSON FAMILY STRONG CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-537-7237
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-1126
Mailing Address - Country:US
Mailing Address - Phone:912-537-7237
Mailing Address - Fax:
Practice Address - Street 1:104 E 2ND ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4709
Practice Address - Country:US
Practice Address - Phone:912-537-7237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006920101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty