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General NPI Number Information
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NPI Number | 1003168170
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Entity Type | Organization
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Legal Business Name | FRAGMENTS MINISTRY INC.
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 635 PEARCE ST SW
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City | ATLANTA
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State | GA
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Zip | 30310-2829
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Country | US
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Telephone | 404-755-3237
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Fax | 404-755-3237
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Provider Business Mailing Address
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Address Line | 5793 JAMES RD
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City | AUSTELL
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State | GA
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Zip | 30168-4505
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Country | US
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Telephone | 678-598-0651
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | GERALD LEON CLOUD
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Credential | MINISTER
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Telephone | 678-598-0651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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