Healthcare Provider Details

I. General information

NPI: 1811095540
Provider Name (Legal Business Name): YOUTH EMPOWERMENT PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DENHAM ST
RIVERDALE GA
30274-2018
US

IV. Provider business mailing address

601 DENHAM ST
RIVERDALE GA
30274-2018
US

V. Phone/Fax

Practice location:
  • Phone: 770-909-0808
  • Fax: 770-909-3161
Mailing address:
  • Phone: 770-909-0808
  • Fax: 770-909-3161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. GLENN DOWELL
Title or Position: EXECUTIVE DIRECTOR
Credential: EDD
Phone: 770-909-0808