Healthcare Provider Details

I. General information

NPI: 1487883914
Provider Name (Legal Business Name): FAMILY FUSION SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 CLEVELAND AVE
EAST POINT GA
30344-3423
US

IV. Provider business mailing address

1373 CLEVELAND AVE
EAST POINT GA
30344-3423
US

V. Phone/Fax

Practice location:
  • Phone: 770-934-4202
  • Fax: 404-684-6001
Mailing address:
  • Phone: 770-934-4202
  • Fax: 404-684-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: P P
Title or Position: C
Credential:
Phone: 770-934-4202