MEDICARE: FRAGMENTS MINISTRY INCORPORATED

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	324500000X	Substance Abuse Rehabilitation Facility		GA
2	347B00000X	Bus		GA

General Provider Information

NPI Number	:	1982953022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRAGMENTS MINISTRY INCORPORATED

Provider Business Mailing Address
First Line	:	5793 JAMES RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30168-4505
Country	:	US
Telephone Number	:	678-598-0378
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 PEARCE ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-2829
Country	:	US
Telephone Number	:	404-735-3237
Fax Number	:

Authorized Official
Title or Position	:	D.O.
Name	:	GERALD LEON CLOUD
Credential	:
Telephone Number	:	678-598-0651

Provider Enumeration Date	:	09/05/2012
Last Update Date	:	09/05/2012

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Directions to “FRAGMENTS MINISTRY INCORPORATED ” Practice Location

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