Provider Demographics
NPI:1841078458
Name:COMMUNITY GEORGIA
Entity type:Organization
Organization Name:COMMUNITY GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEONKEI
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-905-2549
Mailing Address - Street 1:1415 HIGHWAY 85 N STE 310
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4185
Mailing Address - Country:US
Mailing Address - Phone:470-905-2549
Mailing Address - Fax:
Practice Address - Street 1:1542 OAKLEAF DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-3268
Practice Address - Country:US
Practice Address - Phone:470-905-2549
Practice Address - Fax:877-540-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health