| Infinity Services Group, LLC | |
|
3601 Hilton Ave Ste 225 Columbus GA 31904-7373 | |
| (229) 669-2080 | |
| (706) 608-8345 |
| Full Name | Infinity Services Group, LLC |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3601 Hilton Ave Ste 225, Columbus, Georgia |
| Authorized Official Name and Position | Subricca Thjuana Hicks (OWNER) |
| Authorized Official Contact | 2296692080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Infinity Services Group, LLC 4326 Braddock Dr Columbus GA 31907-5422 Ph: (229) 669-2080 | Infinity Services Group, LLC 3601 Hilton Ave Ste 225 Columbus GA 31904-7373 Ph: (229) 669-2080 |
| NPI Number | 1164900858 |
|---|---|
| Provider Enumeration Date | 08/03/2018 |
| Last Update Date | 08/03/2018 |
| Medicare PECOS PAC ID | 4981954781 |
|---|---|
| Medicare Enrollment ID | O20180828003719 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164900858 | NPI | - | NPPES |
| 003199361A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Georgia) | Primary |
| Provider Name | Subricca T Hicks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598925430 PECOS PAC ID: 0547452542 Enrollment ID: I20101008000775 |
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