Healthcare Provider Details

I. General information

NPI: 1548449242
Provider Name (Legal Business Name): BESIDE STILL WATERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CLEVELAND AVE SW SUITE 212
ATLANTA GA
30315-7129
US

IV. Provider business mailing address

777 CLEVELAND AVE SW SUITE 212
ATLANTA GA
30315-7129
US

V. Phone/Fax

Practice location:
  • Phone: 404-761-3500
  • Fax:
Mailing address:
  • Phone: 404-761-3500
  • Fax:

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. TROY D ROLLINS
Title or Position: EXECUTIVE DIRECTOR
Credential: MS; MBA
Phone: 404-761-3500