Healthcare Provider Details

I. General information

NPI: 1700328309
Provider Name (Legal Business Name): HEALTH EDUCATION ASSESSMENT AND LEADERSHIP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 BAKERS FERRY RD SW MILES ELEMENTARY SCHOOL
ATLANTA GA
30331-4401
US

IV. Provider business mailing address

3915 CASCADE RD SW
ATLANTA GA
30331-8512
US

V. Phone/Fax

Practice location:
  • Phone: 678-791-1165
  • Fax: 404-758-1216
Mailing address:
  • Phone: 404-564-7749
  • Fax: 404-758-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateGA

VIII. Authorized Official

Name: SHAWN WRIGHT
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 404-564-7749