Provider Demographics
NPI:1407363757
Name:SOUTHWEST GEORGIA ASSOCIATION FOR AGING AND CONVALESCENT PERSONS
Entity Type:Organization
Organization Name:SOUTHWEST GEORGIA ASSOCIATION FOR AGING AND CONVALESCENT PERSONS
Other - Org Name:SLATER H KING ADH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARNER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ECKLER
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:229-439-9686
Mailing Address - Street 1:400 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2803
Mailing Address - Country:US
Mailing Address - Phone:229-439-9686
Mailing Address - Fax:229-439-9698
Practice Address - Street 1:400 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2803
Practice Address - Country:US
Practice Address - Phone:229-439-9686
Practice Address - Fax:229-439-9698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAADC000162261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care