Provider Demographics
NPI:1962631259
Name:CENTRAL GEORGIA BEHAVIORAL MANAGEMENT LLC
Entity Type:Organization
Organization Name:CENTRAL GEORGIA BEHAVIORAL MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-298-2230
Mailing Address - Street 1:217 RAINBOW RD
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-7716
Mailing Address - Country:US
Mailing Address - Phone:478-298-2230
Mailing Address - Fax:
Practice Address - Street 1:143 N THIRD ST
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-9563
Practice Address - Country:US
Practice Address - Phone:478-298-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health