| Mcintosh Trail Community Service Board | |
|
245 Booker Ave Suite F Fayetteville GA 30215 | |
| (770) 358-5252 | |
| (770) 229-3223 |
| Full Name | Mcintosh Trail Community Service Board |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 245 Booker Ave, Fayetteville, Georgia |
| Authorized Official Name and Position | Kenyatta Denise Walker (CEO) |
| Authorized Official Contact | 7703585252 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcintosh Trail Community Service Board 1435 North Expressway Suite 301 Griffin GA 30223 Ph: (770) 358-5252 | Mcintosh Trail Community Service Board 245 Booker Ave Suite F Fayetteville GA 30215 Ph: (770) 358-5252 |
| NPI Number | 1689852840 |
|---|---|
| Provider Enumeration Date | 02/08/2008 |
| Last Update Date | 06/23/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689852840 | NPI | - | NPPES |
| 000601609M | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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