Healthcare Provider Details

I. General information

NPI: 1134297328
Provider Name (Legal Business Name): UNITED CEREBRAL PALSY OF GEORGIA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 10/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 NORTHEAST EXPY NE BLDG 9
ATLANTA GA
30341-3932
US

IV. Provider business mailing address

3300 N.E. EXPRESSWAY BLDG 9
ATLANTA GA
30341
US

V. Phone/Fax

Practice location:
  • Phone: 770-676-2000
  • Fax: 770-455-8040
Mailing address:
  • Phone: 770-676-2000
  • Fax: 770-455-8040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE WILUSH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 770-676-2000