Healthcare Provider Details

I. General information

NPI: 1679848295
Provider Name (Legal Business Name): HUMANITY UNITED WITH GOD FOR SOCIETY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 CLEVELAND AVE SUITE 2D
ATLANTA GA
30344-3417
US

IV. Provider business mailing address

1203 CLEVELAND AVE SUITE 2D
ATLANTA GA
30344-3417
US

V. Phone/Fax

Practice location:
  • Phone: 404-228-2222
  • Fax: 404-228-2923
Mailing address:
  • Phone: 404-228-2222
  • Fax: 404-228-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number060-532-D
License Number StateGA

VIII. Authorized Official

Name: DERRICK BILLINGSLEA
Title or Position: CEO
Credential: CCT, CCS
Phone: 404-228-2222