Healthcare Provider Details

I. General information

NPI: 1164386686
Provider Name (Legal Business Name): DISTINGUISHED JOURNEYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4166 SNAPFINGER WOODS DR
DECATUR GA
30035-3411
US

IV. Provider business mailing address

320 LANIER AVE W STE 200
FAYETTEVILLE GA
30214-7443
US

V. Phone/Fax

Practice location:
  • Phone: 404-947-8303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE R WALTON
Title or Position: OWNER/PROGRAM DIRECTOR
Credential:
Phone: 678-527-9699