Healthcare Provider Details

I. General information

NPI: 1730122482
Provider Name (Legal Business Name): GA DEPARTMENT OF HUMAN RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3073 PANTHERSVILLE ROAD
DECATUR GA
30034-3828
US

IV. Provider business mailing address

P.O. BOX 370407
DECATUR GA
30034-3828
US

V. Phone/Fax

Practice location:
  • Phone: 404-243-2158
  • Fax: 404-243-2159
Mailing address:
  • Phone: 404-212-5454
  • Fax: 404-243-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number044-232
License Number StateGA

VIII. Authorized Official

Name: SONNY SLATE
Title or Position: CHIEF OPERATIONS OFFICER
Credential: COO
Phone: 404-243-2121