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Middle Flint Community Board

Organization Active NPI Clinic Pharmacy · Cordele, GA

NPI 1811902448 · NPPES record last updated Sep 16, 2016

Key facts

NPI
1811902448
Entity type
Organization (NPI type 2)
Primary specialty
Clinic Pharmacy 3336C0002X
License
PHRE006306 (GA)
Legal business name
MIDDLE FLINT COMMUNITY BOARD
Practice address
1335 N 5TH Street Ext
Cordele, GA 31015-3753
Phone
(229) 276-2367
Fax
(229) 931-2474
NPI assigned
Jul 30, 2006
Organization subpart
No

Authorized official

Name
Pam Davis
Title
Exec Dir
Phone
(229) 931-2470

Corporate family (same tax ID) 23

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Middle Flint Behavior H (24 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X PHRE006306 GA Yes

Addresses

Primary practice location

1335 N 5TH Street Ext
Cordele, GA 31015-3753

Mailing address

PO Box 1348
Americus, GA 31709-1348
Phone (229) 931-2474

Other identifiers

IdentifierTypeStateIssuer
734807561BMedicaidGA
2015417OtherPK

Other names

  • CRISP COMMUNITY MENTAL HEALTH CENTER Doing business as

Other providers in Cordele, GA

All providers in Cordele, GA · Clinic Pharmacy in Georgia

Sources for this page

Verify at the official NPI Registry.