NPIMap

Organization Active NPI

Community Service Board of Middle Georgia

Doing business as Community Mental Health Center of Middle Georgia

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dublin, GA
National Provider Identifier
1689657637
Registry record updated Jan 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
007-R-0003 Issued in GA
Legal business name
COMMUNITY SERVICE BOARD OF MIDDLE GEORGIA
Doing business as
Community Mental Health Center of Middle Georgia
Practice address
2121A Bellevue Rd
Dublin, GA 31021-2998
Phone
(478) 272-1190
Fax
(478) 274-7628
NPI assigned
Nov 23, 2005
Last updated
Jan 12, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Keith Moran
Title
Chief Financial Officer
Phone
(478) 272-1190

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 007-R-0003 GA Primary

Addresses

Primary practice location

2121A Bellevue Rd
Dublin, GA 31021-2998

Mailing address

2121A Bellevue Rd
Dublin, GA 31021-2998
Phone (478) 272-1190

Other identifiers 2

IdentifierTypeStateIssuer
000606284HMedicaidGA
300030912AMedicaidGA

Other names 1

  • Community Mental Health Center of Middle Georgia Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040415000940 GA Part B Supplier - Clinic/Group Practice 3173518644 Receives reassigned benefits from 18 practitioners
Practice locations: Waynesboro, GA; Swainsboro, GA; Dublin, GA; Sylvania, GA

National Provider Directory

National Provider Directory

Locations

302 E Ogeechee St
Sylvania, GA 30467
Phone (912) 546-7825

292 W 4th St
Waynesboro, GA 30830
Phone (706) 437-6863

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452556800000",
    "number": "1689657637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121A BELLEVUE RD",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212998",
            "telephone_number": "478-272-1190",
            "fax_number": "478-274-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121A BELLEVUE RD",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212998",
            "telephone_number": "478-272-1190",
            "fax_number": "478-274-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY SERVICE BOARD OF MIDDLE GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-23",
        "last_updated": "2016-01-12",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "478-272-1190",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": "007-R-0003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000606284H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300030912A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Mental Health Center of Middle Georgia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dublin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.