NPIMap

Organization Active NPI

South Georgia CSB

Doing business as Tift C&A Outpatient Services

  • Adolescent and Children Mental Health Clinic/Center
  • Tifton, GA
National Provider Identifier
1942374343
Registry record updated Mar 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
SOUTH GEORGIA CSB
Doing business as
Tift C&A Outpatient Services
Practice address
340 Tifton Eldorado Road
Tifton, GA 31794
Phone
(229) 391-2350
Fax
(229) 386-7099
NPI assigned
Nov 17, 2006
Last updated
Mar 17, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

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

Authorized official

Name
Mr. Charles R Powell
Title
Chief Executive Officer
Phone
(229) 671-6101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU Primary

Addresses

Primary practice location

340 Tifton Eldorado Road
Tifton, GA 31794

Mailing address

340 Tifton Eldorado Road
Tifton, GA 31794
Phone (229) 391-2350

Other identifiers 1

IdentifierTypeStateIssuer
777050079AMedicaidGA

Other names 1

  • Tift C&A Outpatient Services Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Behavioral Health SVC29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1942374343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 TIFTON ELDORADO ROAD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-391-2350",
            "fax_number": "229-386-7099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 TIFTON ELDORADO ROAD",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-391-2350",
            "fax_number": "229-386-7099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA CSB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "229-671-6101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "777050079A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tift C&A Outpatient Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; 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.