Healthcare Provider Details

I. General information

NPI: 1083311906
Provider Name (Legal Business Name): UPREACH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 MOUNT WILKINSON PKWY SE UNIT 1001
ATLANTA GA
30339-3681
US

IV. Provider business mailing address

PO BOX 91250
ATLANTA GA
30364-1250
US

V. Phone/Fax

Practice location:
  • Phone: 404-558-2055
  • Fax: 470-237-2396
Mailing address:
  • Phone: 404-558-2055
  • Fax: 470-237-2396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD R MOUZON
Title or Position: CEO
Credential: PHD
Phone: 404-558-2055