Healthcare Provider Details

I. General information

NPI: 1548382997
Provider Name (Legal Business Name): DOUGLAS SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 CAMBRIDGE HILL DR
DACULA GA
30019-1620
US

IV. Provider business mailing address

PO BOX 491051
LAWRENCEVILLE GA
30049-0018
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-5895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number067-R-0068
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number067-R-0068
License Number StateGA

VIII. Authorized Official

Name: MR. GARRISON DOUGLAS
Title or Position: VP OF FINANCE
Credential:
Phone: 770-339-5895