Healthcare Provider Details

I. General information

NPI: 1023219284
Provider Name (Legal Business Name): HILLSIDE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 COURTENAY DRIVE
ATLANTA GA
30306
US

IV. Provider business mailing address

690 COURTENAY DRIVE
ATLANTA GA
30306
US

V. Phone/Fax

Practice location:
  • Phone: 404-875-4551
  • Fax: 404-892-2201
Mailing address:
  • Phone: 404-875-4551
  • Fax: 404-892-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number060-411
License Number StateGA

VIII. Authorized Official

Name: MRS. TERESA PAULETTE STOKER
Title or Position: CEO
Credential: M.ED.
Phone: 404-875-4551