Healthcare Provider Details

I. General information

NPI: 1265732127
Provider Name (Legal Business Name): ACHOR CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PEYTON PL SW
ATLANTA GA
30311-1616
US

IV. Provider business mailing address

180 PEYTON PL SW
ATLANTA GA
30311-1616
US

V. Phone/Fax

Practice location:
  • Phone: 404-699-5657
  • Fax: 404-699-5965
Mailing address:
  • Phone: 404-699-5657
  • Fax: 404-699-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER CALLOWAY
Title or Position: BOARD CHAIR
Credential:
Phone: 404-699-5657