Provider Demographics
NPI:1194128017
Name:SEAJOY FAMILY SERVICE CENTER
Entity type:Organization
Organization Name:SEAJOY FAMILY SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-974-4820
Mailing Address - Street 1:3540 WHEELER RD
Mailing Address - Street 2:SUITE 508
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1871
Mailing Address - Country:US
Mailing Address - Phone:706-733-4515
Mailing Address - Fax:706-733-4517
Practice Address - Street 1:3540 WHEELER RD
Practice Address - Street 2:SUITE 508
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1871
Practice Address - Country:US
Practice Address - Phone:706-733-4515
Practice Address - Fax:706-733-4517
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEAJOY FAMILY SERVICE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003146054AMedicaid