| Mcintosh Trail Csb | |
|
160 Carnegie Pl Fayetteville GA 30214-3905 | |
| (770) 461-1351 | |
| Not Available |
| Full Name | Mcintosh Trail Csb |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 160 Carnegie Pl, Fayetteville, Georgia |
| Authorized Official Name and Position | Mike Hubbard (CEO) |
| Authorized Official Contact | 7703588251 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcintosh Trail Csb 1435 N Expressway Suite 301 Griffin GA 30223-9016 Ph: (770) 358-8250 | Mcintosh Trail Csb 160 Carnegie Pl Fayetteville GA 30214-3905 Ph: (770) 461-1351 |
| NPI Number | 1750569919 |
|---|---|
| Provider Enumeration Date | 02/08/2008 |
| Last Update Date | 12/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750569919 | NPI | - | NPPES |
| 000603435J | Medicaid | GA | |
| 000603435K | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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