Provider Demographics
NPI:1578122578
Name:GEORGIA DEPT OF HUMAN RESOUCES FIELD FISCAL SERVICES - REGION II
Entity Type:Organization
Organization Name:GEORGIA DEPT OF HUMAN RESOUCES FIELD FISCAL SERVICES - REGION II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OPERATIONS GENERALIST SUP
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-531-4558
Mailing Address - Street 1:PO BOX 3250
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-3250
Mailing Address - Country:US
Mailing Address - Phone:770-531-4558
Mailing Address - Fax:770-531-4569
Practice Address - Street 1:447 EE BUTLER PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4524
Practice Address - Country:US
Practice Address - Phone:770-531-4558
Practice Address - Fax:770-531-4569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health