Provider Demographics
NPI:1750612230
Name:GEORGIA MADISON COMMUNITY ALTERNATIVES, INC.
Entity type:Organization
Organization Name:GEORGIA MADISON COMMUNITY ALTERNATIVES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-392-8775
Mailing Address - Street 1:PO BOX 13245
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3245
Mailing Address - Country:US
Mailing Address - Phone:336-392-8775
Mailing Address - Fax:866-577-9894
Practice Address - Street 1:4286 BELLS FERRY RD NW STE 202
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1302
Practice Address - Country:US
Practice Address - Phone:404-309-0370
Practice Address - Fax:866-577-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health