Healthcare Provider Details

I. General information

NPI: 1831476399
Provider Name (Legal Business Name): HEALTH EDUCATION, ASSESSMENT AND LEADERSHIP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 CASCADE RD SW
ATLANTA GA
30331-8512
US

IV. Provider business mailing address

3915 CASCADE RD SW
ATLANTA GA
30331-8512
US

V. Phone/Fax

Practice location:
  • Phone: 404-564-7749
  • Fax: 404-758-1216
Mailing address:
  • Phone: 404-564-7749
  • Fax: 404-699-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11D2031396
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DONALD USHER
Title or Position: CEO
Credential:
Phone: 404-564-7749