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Contact Information

MCINTOSH TRAIL COMMUNITY SERVICE BOARD
245 BOOKER AVE
SUITE F
FAYETTEVILLE, GA30215
 Phone: 770-358-5252
 Fax: 770-229-3223
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Behavioral Health

251S00000X
Indicates primary specialty

NPI Profile & details for MCINTOSH TRAIL COMMUNITY SERVICE BOARD

NPI Number 1689852840
LBN Legal business name MCINTOSH TRAIL COMMUNITY SERVICE BOARD
Authorized official KENYATTA WALKER - (CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 02/08/2008
Last updated 06/23/2025 - About 12 months ago
Identifiers
GA Medicaid 000601609M
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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