Healthcare Provider Details

I. General information

NPI: 1467601831
Provider Name (Legal Business Name): J T COMMUNITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 WASHINGTON ST SW
ATLANTA GA
30315-1609
US

IV. Provider business mailing address

1069 WASHINGTON ST SW
ATLANTA GA
30315-1609
US

V. Phone/Fax

Practice location:
  • Phone: 404-622-7343
  • Fax: 404-622-7343
Mailing address:
  • Phone: 404-622-7343
  • Fax: 404-622-7343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNIE MURRAY
Title or Position: DIRECTOR
Credential:
Phone: 404-622-7343