Healthcare Provider Details

I. General information

NPI: 1992209811
Provider Name (Legal Business Name): GOOD LANDING RECOVERY, CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 MCMILLAN RD STE B
DACULA GA
30019-2337
US

IV. Provider business mailing address

3437 SANDY BANK DR
AUBURN GA
30011-4679
US

V. Phone/Fax

Practice location:
  • Phone: 770-570-7422
  • Fax:
Mailing address:
  • Phone: 770-570-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC005933
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. ROBERT PEARSON LEWIS III
Title or Position: CEO/OWNER
Credential:
Phone: 770-570-7422