Healthcare Provider Details

I. General information

NPI: 1225123383
Provider Name (Legal Business Name): EASTER SEALS NORTH GEORGIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 PERIMETER CENTER EAST SUITE 550
ATLANTA GA
30346
US

IV. Provider business mailing address

53 PERIMETER CENTER EAST SUITE 550
ATLANTA GA
30346
US

V. Phone/Fax

Practice location:
  • Phone: 404-943-1070
  • Fax: 404-943-0890
Mailing address:
  • Phone: 404-943-1070
  • Fax: 404-943-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License NumberCH002718
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. DONNA MARIE DAVIDSON
Title or Position: PRESIDENT AND CEO
Credential: M.ED
Phone: 404-943-1070