Provider Demographics
NPI:1376609727
Name:GEORGIA PINES COMMUNITY SERVICE BOARD
Entity Type:Organization
Organization Name:GEORGIA PINES COMMUNITY SERVICE BOARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-225-4373
Mailing Address - Street 1:1102 SMITH AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-5739
Mailing Address - Country:US
Mailing Address - Phone:229-225-4335
Mailing Address - Fax:229-225-4374
Practice Address - Street 1:400 S PINETREE BLVD
Practice Address - Street 2:BUILDING 414
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7128
Practice Address - Country:US
Practice Address - Phone:229-225-4335
Practice Address - Fax:229-225-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
GAPHRE0073393336C0003X
GAPHH0074603336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Not Answered3336I0012XSuppliersPharmacyInstitutional Pharmacy