Provider Demographics
NPI:1639855539
Name:GREEN OAKS CENTER
Entity Type:Organization
Organization Name:GREEN OAKS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-891-7300
Mailing Address - Street 1:2443 GA HWY 133 SOUTH PO BOX 2677
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31788
Mailing Address - Country:US
Mailing Address - Phone:229-891-7300
Mailing Address - Fax:229-891-7303
Practice Address - Street 1:2443 GA HWY 133 SOUTH
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788
Practice Address - Country:US
Practice Address - Phone:229-891-7300
Practice Address - Fax:229-891-7303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities