Organization Name: | SOUTH GEORGIA CSB |
NPI Number: | 1154494359 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUE GUPTON (CHIEF EXECUTIVE OFFICER) |
Mailing Address: | 1200 Roundtree St Quitman |
State: | GA US |
Postal Code: | 316433712 |
Phone Number: | 2292637510 |
Fax Number: | 2292634925 |
NPI Enumeration Date: | 11/16/2006 |
NPI Last Update Date: | 12/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD1600X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Developmental Disabilities |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |