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Contact Information

MCINTOSH TRAIL CSB
1501A KALAMAZOO DR
GRIFFIN, GA30224-3919
 Phone: 770-358-8250
 Fax: 770-229-3223
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinic Pharmacy

3336C0002X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for MCINTOSH TRAIL CSB

NPI Number 1932368974
LBN Legal business name MCINTOSH TRAIL CSB
Authorized official PAMELA MCCOLLUM - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 06/05/2008
Last updated 06/11/2008 - About 18 years ago
Identifiers
GA License # PHRE005229
GA Medicaid 000251666A
GA Other 1123645 NCPDP
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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