Healthcare Provider Details

I. General information

NPI: 1851455919
Provider Name (Legal Business Name): NPTC OF GBCH&FM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 LAWRENCE ST NE
MARIETTA GA
30060-2143
US

IV. Provider business mailing address

729 LAWRENCE ST NE
MARIETTA GA
30060-2143
US

V. Phone/Fax

Practice location:
  • Phone: 770-514-8255
  • Fax: 770-514-1747
Mailing address:
  • Phone: 770-514-8255
  • Fax: 770-514-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number00041071
License Number StateGA

VIII. Authorized Official

Name: MRS. VICTORIA JONES
Title or Position: PROGRAM COORDINATOR
Credential:
Phone: 770-514-8255