Healthcare Provider Details

I. General information

NPI: 1043437742
Provider Name (Legal Business Name): BREAKTHROUGH ADDICTION RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 MILLER CT E
NORCROSS GA
30071-1456
US

IV. Provider business mailing address

8000 MILLER CT E
NORCROSS GA
30071-1456
US

V. Phone/Fax

Practice location:
  • Phone: 770-734-8091
  • Fax: 770-734-8094
Mailing address:
  • Phone: 770-734-8091
  • Fax: 770-734-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number00205360
License Number StateGA

VIII. Authorized Official

Name: MR. SONNY CALHOUN
Title or Position: MANAGING PARTNER
Credential:
Phone: 770-352-4374