Provider Demographics
NPI:1861947772
Name:AUGUSTA COMMUNITY SERVICES INC
Entity type:Organization
Organization Name:AUGUSTA COMMUNITY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-736-4339
Mailing Address - Street 1:1720 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5737
Mailing Address - Country:US
Mailing Address - Phone:706-736-4339
Mailing Address - Fax:706-738-3548
Practice Address - Street 1:1720 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5737
Practice Address - Country:US
Practice Address - Phone:706-736-4339
Practice Address - Fax:706-738-3548
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH AMERICA AUGUSTA CHAPTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-20
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000000000302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization