Provider Demographics
NPI:1548459456
Name:TRANSITIONS OF AUGUSTA
Entity type:Organization
Organization Name:TRANSITIONS OF AUGUSTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M.
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:706-364-7165
Mailing Address - Street 1:103 ROSSMORE PL
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5769
Mailing Address - Country:US
Mailing Address - Phone:706-364-7165
Mailing Address - Fax:706-869-7600
Practice Address - Street 1:103 ROSSMORE PL
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5769
Practice Address - Country:US
Practice Address - Phone:706-364-7165
Practice Address - Fax:706-869-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGNBMedicare PIN
GAS21522Medicare UPIN