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NPI Code Detail

MEDICARE: FULTON COUNTY MHDDAD

MEDICARE: FULTON COUNTY MHDDAD
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

General Provider Information

NPI Number : 1861568271
Entity Type Code : Organization
Provider Name (Legal Business Name) : FULTON COUNTY MHDDAD
Provider Business Mailing Address
First Line : 1636 CONNALLY DR
Second Line :
City : EAST POINT
State : GA
Zip : 30344-2558
Country : US
Telephone Number : 404-762-4042
Fax Number :
Provider Business Practice Location Address
First Line : 1636 CONNALLY DR
Second Line :
City : EAST POINT
State : GA
Zip : 30344-2558
Country : US
Telephone Number : 404-762-4042
Fax Number :
Authorized Official
Title or Position : HR SPECIALIST
Name : LATANGELA KENDRICK
Credential :
Telephone Number : 404-730-0239
Provider Enumeration Date : 11/28/2006
Last Update Date : 08/22/2020

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Directions to “FULTON COUNTY MHDDAD ” Practice Location

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