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NPI Code Detail

MEDICARE: CHRIS 180, INC.

MEDICARE: CHRIS 180, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003377086
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRIS 180, INC.
Provider Business Mailing Address
First Line : 1017 FAYETTEVILLE RD SE
Second Line :
City : ATLANTA
State : GA
Zip : 30316-2932
Country : US
Telephone Number : 404-486-9034
Fax Number : 404-835-9350
Provider Business Practice Location Address
First Line : 3700 MARTIN LUTHER KING DR SW
Second Line :
City : ATLANTA
State : GA
Zip : 30331-3674
Country : US
Telephone Number : 404-486-9034
Fax Number : 404-835-9350
Authorized Official
Title or Position : CLINIC ADMINSITRATOR
Name : MR. DAN JAMES BELLOR
Credential : BBA, PA, NP, AASEET
Telephone Number : 404-486-9034
Provider Enumeration Date : 03/30/2019
Last Update Date : 06/11/2019

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