Provider Demographics
NPI:1831598572
Name:PREFERRED TREATMENT CENTER, LLC
Entity type:Organization
Organization Name:PREFERRED TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR, ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-232-7556
Mailing Address - Street 1:8152 GEORGIA HIGHWAY 272
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082
Mailing Address - Country:US
Mailing Address - Phone:478-274-8426
Mailing Address - Fax:478-274-8430
Practice Address - Street 1:108 CORPORATE SQ STE A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4252
Practice Address - Country:US
Practice Address - Phone:478-274-8426
Practice Address - Fax:478-274-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty