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General NPI Number Information
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NPI Number | 1033829882
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Entity Type | Organization
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Legal Business Name | COMMON EARTHLING
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 3715 NORTHSIDE PARKWAY NW BUILDING 100-SUITE 500
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City | ATLANTA
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State | GA
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Zip | 30327
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Country | US
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Telephone | 404-793-0924
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Fax | 601-568-9733
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Provider Business Mailing Address
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Address Line | 3715 NORTHSIDE PARKWAY NW BUILDING 100-SUITE 500
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City | ATLANTA
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State | GA
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Zip | 30327
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Country | US
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Telephone | 404-793-0924
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Fax | 601-568-9733
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Authorized Official
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Title or Position | CEO
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Name | REBECCA WILSON
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Credential | LMSW
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Telephone | 404-664-6055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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