NPIMap

Organization Active NPI

Middle Flint Community Board

Doing business as Crisp Community Mental Health Center

  • Clinic Pharmacy
  • Cordele, GA
National Provider Identifier
1811902448
Registry record updated Sep 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
PHRE006306 Issued in GA
Legal business name
MIDDLE FLINT COMMUNITY BOARD
Doing business as
Crisp Community Mental Health Center
Practice address
1335 N 5TH Street Ext
Cordele, GA 31015-3753
Phone
(229) 276-2367
Fax
(229) 931-2474
NPI assigned
Jul 30, 2006
Last updated
Sep 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2016

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

Authorized official

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

Specialties & licenses 1

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

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 2

IdentifierTypeStateIssuer
734807561BMedicaidGA
2015417OtherPK

Other names 1

  • CRISP COMMUNITY MENTAL HEALTH CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Middle Flint Behavior H24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473984000000",
    "number": "1811902448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1348",
            "city": "AMERICUS",
            "state": "GA",
            "postal_code": "317091348",
            "telephone_number": "229-931-2474",
            "fax_number": "229-931-2474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 N 5TH STREET EXT",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310153753",
            "telephone_number": "229-276-2367",
            "fax_number": "229-931-2474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLE FLINT COMMUNITY BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2016-09-16",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "EXEC DIR",
        "authorized_official_telephone_number": "229-931-2470"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "GA",
            "license": "PHRE006306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "734807561B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2015417",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CRISP COMMUNITY MENTAL HEALTH CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cordele, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.