MEDICARE: HUNTER RODGERS CORPORATION

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	261QD1600X	Developmental Disabilities Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003699315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTER RODGERS CORPORATION

Provider Business Mailing Address
First Line	:	3300 WINDFLOWER WAY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-4867
Country	:	US
Telephone Number	:	470-210-2471
Fax Number	:	470-648-4756

Provider Business Practice Location Address
First Line	:	3235 SATELLITE BLVD STE 300
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-8688
Country	:	US
Telephone Number	:	470-210-0471
Fax Number	:	470-648-4756

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ERNELL R THACKER
Credential	:
Telephone Number	:	470-210-2471

Provider Enumeration Date	:	08/18/2023
Last Update Date	:	08/28/2023

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