Healthcare Provider Details

I. General information

NPI: 1881102408
Provider Name (Legal Business Name): AVA FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2018
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 PEACHTREE RD NE STE 500
ATLANTA GA
30326-3236
US

IV. Provider business mailing address

3455 PEACHTREE RD NE STE 500A
ATLANTA GA
30326-3254
US

V. Phone/Fax

Practice location:
  • Phone: 404-354-4388
  • Fax:
Mailing address:
  • Phone: 404-354-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateMS

VIII. Authorized Official

Name: DWAYNE GRAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 919-454-1672