Augusta Addiction Associates
Organization Active NPI Substance Use Disorder Rehabilitation Clinic/Center · Savannah, GA
NPI 1972880417 · NPPES record last updated Jul 29, 2024
Key facts
- NPI
- 1972880417
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X
- Legal business name
- AUGUSTA ADDICTION ASSOCIATES
- Practice address
- 600 Commercial CT
Suite a
Savannah, GA 31406-3674 - Phone
- (912) 352-4357
- Fax
- (912) 352-4395
- NPI assigned
- Nov 11, 2011
- Organization subpart
- Yes
- Parent organization (as reported)
- MEDMARK ATREATMENT CENTERS OF GEORGIA
Authorized official
- Name
- Bruce Jarvie
- Title
- VP, Treasurer
- Phone
- (214) 379-3300
Practitioners 8
-
Eddie Byrd, CLINICAL SUPERVISOR
-
William Joseph Deyette IV, BSW, CACII
-
Hope Michelle Lonon, CADCII
-
Leigh Woods, RN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2033823 | Augusta Addiction Associates, LLC | Certificate of waiver | Dec 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Opioid treatment program
- Medicare-enrolled since Jan 1, 2020
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200107003524 | GA | Part B Supplier - Opioid Treatment Program (Otp) | 4688008261 | Practice locations: Savannah, GA |
National Provider Directory
- Part of
- Medmark Services Inc
Locations
600 Commercial Ct
Ste A
Savannah, GA 31406
Phone (912) 352-4357
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | GA10135-M | GA | |
| Substance Use Disorder Rehabilitation Clinic/Center | 261QR0405X | Yes |
Addresses
Primary practice location
600 Commercial CT
Suite a
Savannah, GA 31406-3674
Mailing address
1720 Lakepointe Dr Ste 117
Lewisville, TX 75057-6425
Phone (214) 379-3300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NTP001069 | Other | GA | OTP LICENSE |
Other names
- Medmark Treatment Centers Savannah
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All providers in Savannah, GA · Substance Use Disorder Rehabilitation Clinic/Center in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.