MEDICARE: DIRECT APPROACH COMMUNITY SUPPORT

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	251S00000X	Community/Behavioral Health Agency		GA

General Provider Information

NPI Number	:	1639572803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT APPROACH COMMUNITY SUPPORT

Provider Business Mailing Address
First Line	:	1195 MILTON TER SE APT 1303
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-2426
Country	:	US
Telephone Number	:	404-358-2842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1195 MILTON TER SE APT 1303
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-2426
Country	:	US
Telephone Number	:	404-358-2842
Fax Number	:

Authorized Official
Title or Position	:	CO-CEO
Name	:	MR. KAREEN KERR
Credential	:
Telephone Number	:	404-358-2842

Provider Enumeration Date	:	10/02/2014
Last Update Date	:	10/02/2014

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Directions to “DIRECT APPROACH COMMUNITY SUPPORT ” Practice Location

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