SOUTH GEORGIA CSB (NPI# 1740320290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740320290 |
| Entity Type | Organization |
| Organization Name | SOUTH GEORGIA CSB |
| Other Organization Name | BEHAVIORAL HEALTH SVCS OF S GEORGIA |
| Practice Address |
3120 N Oak Street Ext Suite C Valdosta GA 31602-1007 |
| Practice Telephone | 2296716140 |
| Practice Fax Number | 2293335263 |
| Mailing Telephone | 2296716140 |
| Mailing Fax Number | 2293335263 |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. SUE B GUPTON (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2296716101 |
| Authorized Official Credential | LMFT,LPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 261QD1600X |
Clinic/Center Specialization: Developmental Disabilities |
Ambulatory Health Care Facilities | ||
| X | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
GA | Ambulatory Health Care Facilities | |
| X | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
GA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Behavioral Health Svcs of S Georgia | 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 |
| 1942374343 | South Georgia Csb | Clinic/Center | 340 Tifton Eldorado Road, Tifton, GA 31794 | 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 |
| Street Address |
3120 N OAK STREET EXT SUITE C |
| City | VALDOSTA |
| State | GA |
| Zip Code | 31602-1007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912986282 | Behavioral Health Services of South Georgia | Clinic/Center | 3120 N Oak Street Ext, Suite C, Valdosta, GA 31602-1007 | 2006-01-13 |
| 1215473467 | Amy Parker | Counselor | 3120 N Oak Street Ext, Valdosta, GA 31602-5909 | 2017-01-12 |
| 1578007704 | Vinson Lee | Marriage & Family Therapist | 3120 N Oak Street Ext, Valdosta, GA 31602-5909 | 2016-12-07 |
| 1790229938 | Nancy Rachel Albritton | Social Worker | 3120 N Oak Street Ext, Valdosta, GA 31602-5909 | 2016-12-07 |
| 1972943389 | Georgia Pines Community Service Board | Community/Behavioral Health | 3120 N Oak Street Ext, Suite B, Valdosta, GA 31602-5909 | 2013-06-29 |
| 1124200415 | Sherry B Hurwitz | Counselor | 3120 N Oak Street Ext, Suite C, Valdosta, GA 31602-5909 | 2007-11-29 |
| 1881734333 | Behavioral Health Services of South Georgia | Clinic/Center | 3120 N Oak Street Ext, Valdosta, GA 31602-1007 | 2007-02-07 |
| 1801932371 | Behavioral Health Services of South Georgia | Clinic/Center | 3120 N Oak Street Ext, Suite C, Valdosta, GA 31602-1007 | 2007-01-30 |
| 1356430193 | Selina Joy Popovich-evans | Counselor | 3120 N Oak Street Ext, Suite C, Valdosta, GA 31602-1007 | 2006-10-12 |
| 1821185513 | Rhea L Kisling | Counselor | 3120 N Oak Street Ext, Suite E, Valdosta, GA 31602-1007 | 2006-10-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477198117 | Amber Michele Baugh | Behavior Technician | 2236 Bemiss Road, Valdosta, GA 31602 | 2019-11-15 |
| 1528611365 | Nishaben T. Patel | Nurse Practitioner | 3120 North Oak Street Extension, Suite B, Valdosta, GA 31602 | 2019-07-22 |
| 1427615871 | Blair Elizabeth Tomlinson | Nurse Practitioner | 2124 Lakeshore Drive, Valdosta, GA 31602 | 2019-05-21 |
| 1346704152 | Mildred Itaska Borowski | Counselor | 3790 North Highway 41, Suite A, Valdosta, GA 31602 | 2019-01-25 |
| 1962991703 | Southern Healthcare Alliance, LLC | Physical Medicine & Rehabilitation | 101-f W. Northside Drive, Valdosta, GA 31602 | 2018-05-08 |
| 1336636646 | Kaitlyn Thrift | Behavioral Analyst | 2225 Bemiss Road Suite D, Valdosta, GA 31602 | 2018-04-23 |
| 1407379845 | Lindsey Marie Richardson | Dentist | 103 W. Cranford Ave, Valdosta, GA 31602 | 2017-07-18 |
| 1962922427 | Taylor Nicole Fiveash | Nurse Practitioner | 101 W Northisde Dr, Bldg G, Valdosta, GA 31602 | 2017-06-26 |
| 1720520646 | Southern Sleepers Anesthesia LLC | Nurse Anesthetist, Certified Registered | 4120-b N. Valdosta Road, Valdosta, GA 31602 | 2016-11-09 |
| 1134670557 | Cataract and Laser Surgery Center of South Georgia, P.C. | Clinic/Center | 4120-b N. Valdosta Rd., Valdosta, GA 31602 | 2016-10-20 |
| Find all providers in zip 31602 | ||||
| Taxonomy Code | 261QD1600X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Developmental Disabilities |
| An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386718187 | South Georgia Csb | Clinic/Center | 1644 E Park Ave, Valdosta, GA 31602-3413 | 2006-11-20 |
| 1912986282 | Behavioral Health Services of South Georgia | Clinic/Center | 3120 N Oak Street Ext, Suite C, Valdosta, GA 31602-1007 | 2006-01-13 |
| 1083754535 | Behavioral Health Services of South Georgia | Clinic/Center | 3120 N Oak Street Ext Ste C, Valdosta, GA 31602-5910 | 2007-02-07 |
| 1639219181 | Behavioral Health Services of South Georgia | Clinic/Center | 3120 N Oak Street Ext Ste C, Valdosta, GA 31602-5910 | 2007-02-07 |
| 1881734333 | Behavioral Health Services of South Georgia | Clinic/Center | 3120 N Oak Street Ext, Valdosta, GA 31602-1007 | 2007-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922653534 | Five Star Education Advocacy Group Inc | Clinic/Center | 978 Fellowship Rd, Fairburn, GA 30213-1789 | 2019-08-09 |
| 1205329687 | Advantage Behavioral Health Systems | Clinic/Center | 638 Michael Cir., Monroe, GA 30655 | 2018-06-11 |
| 1215420690 | Advantage Behavioral Health Systems | Clinic/Center | 1801 Prospect Rd., Madison, GA 30650 | 2018-06-11 |
| 1285149955 | Alicia Gordon | Clinic/Center | 132 Carol Cir, Fitzgerald, GA 31750-8128 | 2017-12-04 |
| 1225567597 | Vincentia Paul-constantin | Clinic/Center | 2867 Country House Lane, Buford, GA 30519 | 2017-06-08 |
| 1598158909 | Musik To Grow | Clinic/Center | 1517 Johnson Ferry Rd, Marietta, GA 30062-6493 | 2015-03-09 |
| 1356692800 | Ridgewood Personal Care Home, Inc | Clinic/Center | 1065 Murray Cir Sw, Marietta, GA 30064-3927 | 2012-09-24 |
| 1790055432 | Trapeze Therapy, LLC | Clinic/Center | 160 Tracy St, Suite A, Athens, GA 30601-1979 | 2012-01-11 |
| 1326316274 | Early/miller Day (now) | Clinic/Center | 302 Damacus Street, Blakely, GA 39823-3346 | 2011-12-07 |
| 1710255773 | Early Miller Personal Support (now) | Clinic/Center | 302 Damascus Street, Blakely, GA 39823-3346 | 2011-12-06 |
| 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.