MEDICARE: THE VILLAGE HEALTH INITIATIVE

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
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1205230307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VILLAGE HEALTH INITIATIVE

Provider Business Mailing Address
First Line	:	750 GLENWOOD AVE SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30316-1867
Country	:	US
Telephone Number	:	404-671-4920
Fax Number	:

Provider Business Practice Location Address
First Line	:	1890 DETROIT AVE NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-1638
Country	:	US
Telephone Number	:	404-671-4920
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GILES LEEPER
Credential	:
Telephone Number	:	404-671-4920

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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Directions to “THE VILLAGE HEALTH INITIATIVE ” Practice Location

Language	Start Address	Practice Location

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