Healthcare Provider Details

I. General information

NPI: 1487920286
Provider Name (Legal Business Name): ALTERNATIVE INTERVENTION METHODS & EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3485 N DESERT DR STE 104
EAST POINT GA
30344-5724
US

IV. Provider business mailing address

510 STONEBRIAR WAY SW
ATLANTA GA
30331-7672
US

V. Phone/Fax

Practice location:
  • Phone: 678-740-6578
  • Fax:
Mailing address:
  • Phone: 678-740-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number745A
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number745A
License Number StateGA

VIII. Authorized Official

Name: MS. TRACY LASHON ROLLE
Title or Position: COORDINATOR
Credential: BA
Phone: 678-592-2783