| Organization Name: | GEORGIA DEPARTMENT OF HUMAN RESOURCES |
| NPI Number: | 1033250972 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTOPHER WADE SELLERS (MEDICAL DIRECTOR) |
| Mailing Address: | 16 E 12th St Sw Rome |
| State: | GA US |
| Postal Code: | 301614720 |
| Phone Number: | 7068025343 |
| Fax Number: | 7068025681 |
| NPI Enumeration Date: | 02/12/2007 |
| NPI Last Update Date: | 07/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP0905X |
| License Number: | 025271 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Public Health, State or Local |
| Taxonomy Definition: | |