Provider Demographics
NPI:1265277073
Name:1ST GENESIS TREATMENT CENTER INC
Entity type:Organization
Organization Name:1ST GENESIS TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-361-7077
Mailing Address - Street 1:1022 HILLCREST PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4258
Mailing Address - Country:US
Mailing Address - Phone:478-272-5020
Mailing Address - Fax:478-272-5024
Practice Address - Street 1:1022 HILLCREST PKWY STE 100
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4258
Practice Address - Country:US
Practice Address - Phone:478-272-5020
Practice Address - Fax:478-272-5024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center