Provider Demographics
NPI:1457733412
Name:PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH
Entity Type:Organization
Organization Name:PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-845-4045
Mailing Address - Street 1:122 GORDON COMMERCIAL DR
Mailing Address - Street 2:SUIRE C
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-5754
Mailing Address - Country:US
Mailing Address - Phone:706-845-4045
Mailing Address - Fax:706-845-4367
Practice Address - Street 1:225 MILLARD FARMER IND BLVD
Practice Address - Street 2:BUILDING C, SUITES 100 & 200
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-3168
Practice Address - Country:US
Practice Address - Phone:678-845-3830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health