Provider Demographics
NPI:1801969175
Name:GEORGIA CORRECTIONAL INDUSTRIES
Entity type:Organization
Organization Name:GEORGIA CORRECTIONAL INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-244-5100
Mailing Address - Street 1:2984 CLIFTON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3820
Mailing Address - Country:US
Mailing Address - Phone:404-244-5100
Mailing Address - Fax:404-244-5141
Practice Address - Street 1:777 UNDERWOOD DR
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1500
Practice Address - Country:US
Practice Address - Phone:706-857-0650
Practice Address - Fax:706-857-0652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier