Healthcare Provider Details

I. General information

NPI: 1346644507
Provider Name (Legal Business Name): BRIGHT ADIRI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARTIN LUTHER KING JR DR SW SUITE 409
ATLANTA GA
30310-1101
US

IV. Provider business mailing address

2001 MARTIN LUTHER KING JR DR SW SUITE 409
ATLANTA GA
30310-1101
US

V. Phone/Fax

Practice location:
  • Phone: 404-564-6486
  • Fax: 404-564-6487
Mailing address:
  • Phone: 404-564-6486
  • Fax: 404-564-6487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: