Healthcare Provider Details

I. General information

NPI: 1336631266
Provider Name (Legal Business Name): THE ATLANTA SMALL BUSINESS TRAINING CONSORTIUM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 GEORGIA AVE SE STE 207A
ATLANTA GA
30312
US

IV. Provider business mailing address

250 GEORGIA AVE SE
ATLANTA GA
30312-3046
US

V. Phone/Fax

Practice location:
  • Phone: 770-906-7015
  • Fax:
Mailing address:
  • Phone: 770-906-7015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. TRENACE CUNNINGHAM PYLES
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 770-906-7015