Healthcare Provider Details

I. General information

NPI: 1336827724
Provider Name (Legal Business Name): MEADOWS OUTPATIENT CENTER GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 GLENRIDGE DR
ATLANTA GA
30342-7200
US

IV. Provider business mailing address

19820 N 7TH ST STE 205
PHOENIX AZ
85024-1694
US

V. Phone/Fax

Practice location:
  • Phone: 602-256-3020
  • Fax:
Mailing address:
  • Phone: 602-256-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TRACY ELIZABETH LIVINGSTON
Title or Position: VICE PRESIDENT REVENUE CYCLE MGMT
Credential:
Phone: 602-256-3020