Healthcare Provider Details

I. General information

NPI: 1144315946
Provider Name (Legal Business Name): POSITIVE IMPACT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 RALPH MCGILL BLVD NE SUITE #301
ATLANTA GA
30308-3339
US

IV. Provider business mailing address

139 RALPH MCGILL BLVD NE SUITE #301
ATLANTA GA
30308-3339
US

V. Phone/Fax

Practice location:
  • Phone: 404-589-9040
  • Fax: 404-589-1615
Mailing address:
  • Phone: 404-589-9040
  • Fax: 404-589-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. PAUL L PLATE
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 404-589-9040