Healthcare Provider Details

I. General information

NPI: 1043452980
Provider Name (Legal Business Name): FRANK MCALLISTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 11/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4151 MEMORIAL DR STE 209C
DECATUR GA
30032-1597
US

IV. Provider business mailing address

4151 MEMORIAL DR STE 209C
DECATUR GA
30032-1597
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-0078
  • Fax: 404-508-0071
Mailing address:
  • Phone: 404-508-0078
  • Fax: 404-508-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC001424
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: