| Organization Name: | SOUTH GEORGIA CSB |
| NPI Number: | 1083787394 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUE GUPTON (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 1905 S Hutchinson Ave Adel |
| State: | GA US |
| Postal Code: | 316205246 |
| Phone Number: | 2298964559 |
| Fax Number: | 2298967663 |
| NPI Enumeration Date: | 11/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM0801X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
| Taxonomy Definition: | |