MEDICARE: BOBBY DODD INSTITUTE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251X00000X	Supports Brokerage Agency
2	253Z00000X	In Home Supportive Care Agency
3	261QD1600X	Developmental Disabilities Clinic/Center
4	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
5	261QM0850X	Adult Mental Health Clinic/Center
6	261QM0855X	Adolescent and Children Mental Health Clinic/Center
7	101Y00000X	Counselor
8	101YA0400X	Addiction (Substance Use Disorder) Counselor
9	225C00000X	Rehabilitation Counselor
10	251C00000X	Developmentally Disabled Services Day Training Agency
11	251S00000X	Community/Behavioral Health Agency
12	251T00000X	PACE Provider Organization
13	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1497307425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOBBY DODD INSTITUTE

Provider Business Mailing Address
First Line	:	2120 MARIETTA BLVD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2122
Country	:	US
Telephone Number	:	678-365-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 MARIETTA BLVD NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2122
Country	:	US
Telephone Number	:	678-365-0071
Fax Number	:

Authorized Official
Title or Position	:	VP OF ADMINISTRATIVE SERVICES
Name	:	MS. VERONICA ROHRLACK
Credential	:
Telephone Number	:	678-365-2264

Provider Enumeration Date	:	07/10/2019
Last Update Date	:	09/13/2024

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