Provider Demographics
NPI:1285341503
Name:TRI STAR DRUG AND ALCOHOL
Entity type:Organization
Organization Name:TRI STAR DRUG AND ALCOHOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:478-246-1027
Mailing Address - Street 1:600 N JEFFERSON ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-6302
Mailing Address - Country:US
Mailing Address - Phone:478-292-5755
Mailing Address - Fax:
Practice Address - Street 1:600 N JEFFERSON ST UNIT C
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-6302
Practice Address - Country:US
Practice Address - Phone:478-292-5755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251E00000XAgenciesHome Health
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1421Medicaid