Healthcare Provider Details

I. General information

NPI: 1891210902
Provider Name (Legal Business Name): SUNSHINE HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 08/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 20TH ST S
BIRMINGHAM AL
35205-2752
US

IV. Provider business mailing address

1021 CHURCH ST SE APT D1
SMYRNA GA
30080-3559
US

V. Phone/Fax

Practice location:
  • Phone: 404-957-6960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: GARY HART
Title or Position: CEO
Credential:
Phone: 404-957-6960