Provider Demographics
NPI:1477129377
Name:SOUTHERN CRESCENT SEXUAL ASSAULT CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHERN CRESCENT SEXUAL ASSAULT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GAYLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NOBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-507-7772
Mailing Address - Street 1:2 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2187
Mailing Address - Country:US
Mailing Address - Phone:770-507-7772
Mailing Address - Fax:
Practice Address - Street 1:2 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2187
Practice Address - Country:US
Practice Address - Phone:770-507-7772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center