SOUTH GEORGIA CSB (NPI# 1942374343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942374343 |
| Entity Type | Organization |
| Organization Name | SOUTH GEORGIA CSB |
| Other Organization Name | TIFT C&A OUTPATIENT SERVICES |
| Practice Address |
340 Tifton Eldorado Road Tifton GA 31794 |
| Practice Telephone | 2293912350 |
| Practice Fax Number | 2293867099 |
| Mailing Telephone | 2293912350 |
| Mailing Fax Number | 2293867099 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2010-03-17 |
| Authorized Official Name | MR. CHARLES R POWELL (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2296716101 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 777050079A | 05 |
| Other Name | Type Code |
|---|---|
| Tift C&A Outpatient Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053624585 | South Georgia Csb | Community Based Residential Treatment Facility, Mental Illness | 1209 N Toombs St, Valdosta, GA 31601-3931 | 2010-07-26 |
| 1386718187 | South Georgia Csb | Clinic/Center | 1644 E Park Ave, Valdosta, GA 31602-3413 | 2006-11-20 |
| 1871667675 | South Georgia Csb | Clinic/Center | 1108 S Patterson St, Valdosta, GA 31601-6348 | 2006-11-20 |
| 1730252479 | South Georgia Csb | Clinic/Center | 321 W Brantley, Lakeland, GA 31635 | 2006-11-17 |
| 1942374350 | South Georgia Csb | Clinic/Center | 203 Industrial Park Drive, Adel, GA 31620 | 2006-11-17 |
| 1154494359 | South Georgia Csb | Clinic/Center | 1200 Roundtree St, Quitman, GA 31643-3712 | 2006-11-16 |
| 1356414569 | South Georgia Csb | Clinic/Center | 391 County Farm Rd, Ashburn, GA 31714-3413 | 2006-11-16 |
| 1578636817 | South Georgia Csb | Residential Treatment Facility, Emotionally Disturbed Children | 4401 Willow Wood Gate, Valdosta, GA 31602-6709 | 2006-11-16 |
| 1407929730 | South Georgia Csb | Clinic/Center | 252 N Saint Augustine Rd, Valdosta, GA 31601-5274 | 2006-11-16 |
| 1558457655 | South Georgia Csb | Community/Behavioral Health | 334 Tifton Eldorado Rd, Tifton, GA 31794-9497 | 2006-10-05 |
| Street Address |
340 TIFTON ELDORADO ROAD |
| City | TIFTON |
| State | GA |
| Zip Code | 31794 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234043 | Deloris Lunsford | Licensed Practical Nurse | 903 Washington St., Tifton, GA 31794 | 2020-01-17 |
| 1194383075 | William Jordan Kinnett | Registered Nurse | 1205 Tift Ave N, Tifton, GA 31794 | 2019-06-05 |
| 1598321200 | Courtlyn Christanna Fussell | Pharmacist | 2201 Hwy 41 N, Tifton, GA 31794 | 2019-05-17 |
| 1376027722 | Martha Gibbs | Nurse Practitioner | Affinity Clinic/west Campus, 2225 Us Hwy 41 North, Tifton, GA 31794 | 2018-09-21 |
| 1427541044 | Rebekah F Cottle | Speech-Language Pathologist | 2227 Highway 41 North, Tifton, GA 31794 | 2018-06-08 |
| 1790280857 | Tift Regional Health System Inc | Ophthalmology | 1803 Old Ocilla Road, Tifton, GA 31794 | 2018-03-29 |
| 1568975431 | Skyler Clark | Pharmacist | 2201 North 12th Street, Tifton, GA 31794 | 2017-11-14 |
| 1538606306 | Imagine Peace Counseling LLC | Counselor | 223 E 2nd Street, Suite B, Tifton, GA 31794 | 2017-01-31 |
| 1073056347 | Jessica Tumbling | Contractor | 219 Savannah Way, Tifton, GA 31794 | 2016-11-18 |
| 1992159503 | Joseph Thomas Seagraves Jr. | Nurse Practitioner | 901 East 18th Street, Tifton, GA 31794 | 2016-04-20 |
| Find all providers in zip 31794 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306451265 | Chrystal Care | Clinic/Center | 3206 Stratford Cir, Morrow, GA 30260-8111 | 2020-09-08 |
| 1114536372 | The Mindful Match, LLC | Clinic/Center | 528b Angier Ave Ne, Atlanta, GA 30308-2902 | 2020-07-23 |
| 1427666817 | Atlanta Child and Family Therapy, LLC | Clinic/Center | 2144 Kodiak Dr Ne, Atlanta, GA 30345-4150 | 2020-07-21 |
| 1407474778 | Your Way Out, LLC | Clinic/Center | 2330 Scenic Hwy S Ste 316, Snellville, GA 30078-3115 | 2020-07-13 |
| 1073141271 | Monte Nido Georgia LLC | Clinic/Center | 126 Johnson Ferry Road Ne, Sandy Springs, GA 30328-3004 | 2020-04-01 |
| 1700418142 | Behavior Therapy Solutions LLC | Clinic/Center | 4744 N Royal Atlanta Dr Ste A, Tucker, GA 30084-3820 | 2020-02-04 |
| 1730721036 | Brown Professional Counseling & Consultation Services, LLC | Clinic/Center | 1105 Russell Pkwy Ste 2, Warner Robins, GA 31088-5586 | 2019-10-09 |
| 1184182115 | Pathways To Recovery Associates Inc. | Clinic/Center | 7210 Church St, Riverdale, GA 30274-2918 | 2019-03-08 |
| 1336614254 | Learn & Grow Family Counseling, LLC | Clinic/Center | 327 Dahlonega St Ste 402, Cumming, GA 30040-2486 | 2018-10-07 |
| 1790271633 | Jill Elizabeth Gresham | Clinic/Center | 750 Hammond Dr Ste 100, Atlanta, GA 30328-5532 | 2018-07-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.