| Angela Roe | |
|
805 Moore Ave La Fayette GA 30728-3321 | |
| (706) 638-5580 | |
| (706) 639-2054 |
| Full Name | Angela Roe |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 805 Moore Ave, La Fayette, Georgia |
| Authorized Official Name and Position | Tom Ford (CEO) |
| Authorized Official Contact | 7066385584 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Angela Roe Po Box 1027 La Fayette GA 30728-1027 Ph: (706) 638-5580 | Angela Roe 805 Moore Ave La Fayette GA 30728-3321 Ph: (706) 638-5580 |
| NPI Number | 1518418367 |
|---|---|
| Provider Enumeration Date | 10/17/2016 |
| Last Update Date | 10/17/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518418367 | NPI | - | NPPES |
| 000810059M | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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Linda Dale Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1929 Villanow Mill Creek Rd, La Fayette, GA 30728 Phone: 706-638-5580 Fax: 706-638-5445 | |
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