Healthcare Provider Details

I. General information

NPI: 1356278253
Provider Name (Legal Business Name): GREGORY ANDERSON CADC-T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 CROSSROADS DR
ACWORTH GA
30102-2536
US

IV. Provider business mailing address

PO BOX 2699
WOODSTOCK GA
30188-1384
US

V. Phone/Fax

Practice location:
  • Phone: 470-704-8085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: