Healthcare Provider Details

I. General information

NPI: 1972225381
Provider Name (Legal Business Name): TIME ORGANIZATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 NORMAN BERRY DR
ATLANTA GA
30344-5121
US

IV. Provider business mailing address

3401 NORMAN BERRY DR
ATLANTA GA
30344-5121
US

V. Phone/Fax

Practice location:
  • Phone: 410-227-9426
  • Fax:
Mailing address:
  • Phone: 410-227-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LAUREN HERRON
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential: LCSW-C
Phone: 410-227-9426