Healthcare Provider Details

I. General information

NPI: 1891557492
Provider Name (Legal Business Name): RISING SUN RECOVERY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3446 PARSONS GREENE CT
POWDER SPRINGS GA
30127-4428
US

IV. Provider business mailing address

3446 PARSONS GREENE CT
POWDER SPRINGS GA
30127-4428
US

V. Phone/Fax

Practice location:
  • Phone: 404-200-8907
  • Fax:
Mailing address:
  • Phone: 404-200-8907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY RAY MOON
Title or Position: EXECUTIVE DIRECTOR
Credential: CPS-AD
Phone: 404-200-8907