Healthcare Provider Details

I. General information

NPI: 1295159010
Provider Name (Legal Business Name): ONE COMMUNITY BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3783 PRESIDENTIAL PKWY SUITE 125
ATLANTA GA
30340-3709
US

IV. Provider business mailing address

3783 PRESIDENTIAL PKWY SUITE 125
ATLANTA GA
30340-3709
US

V. Phone/Fax

Practice location:
  • Phone: 202-246-7248
  • Fax:
Mailing address:
  • Phone: 202-246-7248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. ADIB S SHAKIR
Title or Position: PROGRAM DIRECTOR
Credential: ED.S
Phone: 202-246-7248