Healthcare Provider Details

I. General information

NPI: 1477214765
Provider Name (Legal Business Name): ATLANTA TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 THE EXCHANGE SE STE 375
ATLANTA GA
30339-7405
US

IV. Provider business mailing address

1755 THE EXCHANGE SE STE 375
ATLANTA GA
30339-7405
US

V. Phone/Fax

Practice location:
  • Phone: 404-333-8301
  • Fax: 470-468-9062
Mailing address:
  • Phone: 404-333-8301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: UFUOMA OYIBO
Title or Position: DIRECTOR
Credential: CADCII, CAMSII
Phone: 404-333-8301