Provider Demographics
NPI:1982099693
Name:GEORGIA DETOX AND RECOVERY CENTERS, LLC MACON
Entity Type:Organization
Organization Name:GEORGIA DETOX AND RECOVERY CENTERS, LLC MACON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-868-1607
Mailing Address - Street 1:2300 WINDY RIDGE PARKWAY
Mailing Address - Street 2:SUITE 210 SOUTH
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339
Mailing Address - Country:US
Mailing Address - Phone:561-868-1607
Mailing Address - Fax:561-697-4345
Practice Address - Street 1:655 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2852
Practice Address - Country:US
Practice Address - Phone:561-868-1607
Practice Address - Fax:561-697-4345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERMEND HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-31
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121-253-D324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility