Healthcare Provider Details

I. General information

NPI: 1043549686
Provider Name (Legal Business Name): NORTH GEORGIA CHILDREN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 DAHLONEGA HWY
CUMMING GA
30040-4528
US

IV. Provider business mailing address

PO BOX 38
CUMMING GA
30028-0038
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-8664
  • Fax: 770-844-8643
Mailing address:
  • Phone: 770-844-8664
  • Fax: 770-844-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MS. JESSICA L PUGH
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, BCBA
Phone: 770-844-8664