Healthcare Provider Details

I. General information

NPI: 1568903805
Provider Name (Legal Business Name): SKYLARK ADH-POWERS FERRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 INTERSTATE NORTH PKWY EAST, SE SUITE 420
ATLANTA GA
30339-2164
US

IV. Provider business mailing address

120 INTERSTATE NORTH PARKWAY EAST, SE SUITE 420
ATLANTA GA
30339-2164
US

V. Phone/Fax

Practice location:
  • Phone: 678-741-3900
  • Fax: 678-741-3901
Mailing address:
  • Phone: 678-741-3900
  • Fax: 678-741-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC000088
License Number StateGA

VIII. Authorized Official

Name: MR. EDWIN HOWARD MORGENS
Title or Position: CEO
Credential:
Phone: 770-476-8400