Basic Information
| Provider Information | |||||||||
| NPI: | 1073908786 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGIA DETOX AND RECOVERY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WINDY RIDGE PARKWAY | ||||||||
| Address2: | SUITE 210S | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4704401647 | ||||||||
| FaxNumber: | 5616974345 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 BRIARCLIFF RD | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306063404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618681607 | ||||||||
| FaxNumber: | 5616974345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2015 | ||||||||
| LastUpdateDate: | 07/28/2017 | ||||||||
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| AuthorizedOfficialLastName: | TOWNSEND | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 4704401647 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RIVERMEND HEALTH, LLC | ||||||||
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| AuthorizedOfficialCredential: | MPH, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | 029-2540-D | GA | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.