GEORGIA CTC LLC NPI 1407582042

NPI Information

  • NPI: 1407582042
  • Provider Name: GEORGIA CTC, LLC
  • Classification: Clinic/Center - 261QM2800X
  • Specialization: Methadone
  • Entity Type: Organization
  • :
  • CLIA Number: 11D2268357
  • Address: 311 WHITE INGRAM PKWY
    DALLAS, GA
    ZIP 30132
  • Phone: (770) 615-0951

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NPI Details

GEORGIA CTC, LLC is a methadone clinic center in Dallas, GA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. GEORGIA CTC, LLC NPI is 1407582042. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

311 WHITE INGRAM PKWY
DALLAS, GA
ZIP 30132-969
Phone: (770) 615-0951
Fax: (678) 363-7787

The provider's authorized official is Brian Phillip Farley .
The authorized official title is Vp & Secretary and has the following contact phone number (615) 716-9335.

The CLIA number assigned to this NPI record is 11D2268357 - comp. outpatient rehab facility with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm (HCPCS:G2067)
  • Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure (HCPCS:G2078)

The enumeration date for this NPI number is 7/26/2022 and was last updated on 9/2/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1251S00000XCommunity/Behavioral HealthNo
2261QR0405XClinic/CenterRehabilitation, Substance Use DisorderNo
3261QM2800XClinic/CenterMethadoneYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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