Provider Demographics
NPI:1578349783
Name:COMMUNITY GEORGIA
Entity Type:Organization
Organization Name:COMMUNITY GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOGAN-PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPPM
Authorized Official - Phone:731-935-9267
Mailing Address - Street 1:1415 HIGHWAY 85 N
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7738
Mailing Address - Country:US
Mailing Address - Phone:470-905-2549
Mailing Address - Fax:877-540-0067
Practice Address - Street 1:1542 OAKLEAF DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-3268
Practice Address - Country:US
Practice Address - Phone:470-905-2549
Practice Address - Fax:877-540-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management