Provider Demographics
NPI:1972880417
Name:AUGUSTA ADDICTION ASSOCIATES
Entity type:Organization
Organization Name:AUGUSTA ADDICTION ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-379-3300
Mailing Address - Street 1:1720 LAKEPOINTE DR STE 117
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6425
Mailing Address - Country:US
Mailing Address - Phone:214-379-3300
Mailing Address - Fax:148-539-0182
Practice Address - Street 1:600 COMMERCIAL CT
Practice Address - Street 2:SUITE A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3674
Practice Address - Country:US
Practice Address - Phone:912-352-4357
Practice Address - Fax:912-352-4395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDMARK ATREATMENT CENTERS OF GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-11
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA10135-M261QM2800X
261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANTP001069OtherOTP LICENSE