Provider Demographics
NPI:1063946788
Name:CENTRAL STATE HOSPITAL
Entity type:Organization
Organization Name:CENTRAL STATE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-445-4303
Mailing Address - Street 1:2450 VINSON HWY SE
Mailing Address - Street 2:COOK BUILDING
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-4881
Mailing Address - Country:US
Mailing Address - Phone:478-445-4303
Mailing Address - Fax:478-445-7941
Practice Address - Street 1:2450 VINSON HWY SE
Practice Address - Street 2:COOK BUILDING
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-4881
Practice Address - Country:US
Practice Address - Phone:478-445-4303
Practice Address - Fax:478-445-7941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital