Provider Demographics
NPI:1659402154
Name:MIDDLE GEORGIA BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:MIDDLE GEORGIA BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-275-4845
Mailing Address - Street 1:402 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-5232
Mailing Address - Country:US
Mailing Address - Phone:478-275-4845
Mailing Address - Fax:478-277-9192
Practice Address - Street 1:402 W MADISON ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-5232
Practice Address - Country:US
Practice Address - Phone:478-275-4845
Practice Address - Fax:478-277-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty