MEDICARE: NORMAL LIFE OF GEORGIA, INC.

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

General Provider Information

NPI Number	:	1881711844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORMAL LIFE OF GEORGIA, INC.

Provider Business Mailing Address
First Line	:	9901 LINN STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3808
Country	:	US
Telephone Number	:	800-866-0860
Fax Number	:

Provider Business Practice Location Address
First Line	:	2296 HENDERSON MILL RD NE
Second Line	:	SUITE 200
City	:	ATLANTA
State	:	GA
Zip	:	30345-2739
Country	:	US
Telephone Number	:	770-414-1350
Fax Number	:

Authorized Official
Title or Position	:	PRIVACY OFFICER
Name	:	MS. DEENA OMBRES
Credential	:
Telephone Number	:	502-394-2387

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	02/01/2008

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