Basic Information
| Provider Information | |||||||||
| NPI: | 1386009520 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGIA DETOX AND RECOVERY, LLC | ||||||||
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| OtherOrganizationName: | GDRC - AUGUSTA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2300 WINDY RIDGE PARKWAY | ||||||||
| Address2: | SUITE 210S | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4704401647 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2812 HILLCREEK DR STE B | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309095632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8442420806 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2015 | ||||||||
| LastUpdateDate: | 04/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | REYNOLDS | ||||||||
| AuthorizedOfficialFirstName: | TYEAST | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF RCM | ||||||||
| AuthorizedOfficialTelephone: | 6788130428 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RIVERMEND HEALH, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | 121-253-D | GA | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.