Provider Demographics
NPI:1669572335
Name:NEPTUNE CLINICAL GROUP, INC.
Entity type:Organization
Organization Name:NEPTUNE CLINICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CCS, CADC2, CAS
Authorized Official - Phone:706-861-6458
Mailing Address - Street 1:822 CHICKAMAUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-1407
Mailing Address - Country:US
Mailing Address - Phone:706-861-6458
Mailing Address - Fax:706-866-6277
Practice Address - Street 1:822 CHICKAMAUGA AVE
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-1407
Practice Address - Country:US
Practice Address - Phone:706-861-6458
Practice Address - Fax:706-866-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-23
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadoneGroup - Single Specialty