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General NPI Number Information
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NPI Number | 1043225758
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Entity Type | Organization
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Legal Business Name | CSA OF ATLANTA, LLC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 1140 HAMMOND DR NE STE K SUITE 350
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City | ATLANTA
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State | GA
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Zip | 30328-7274
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Country | US
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Telephone | 678-735-3201
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Fax | 678-735-3207
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Provider Business Mailing Address
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Address Line | 1140 HAMMOND DR NE STE K SUITE 350
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City | ATLANTA
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State | GA
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Zip | 30328-7274
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Country | US
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Telephone | 678-735-3201
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Fax | 678-735-3207
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. VICKY B CARROLL
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Credential | RN
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Telephone | 678-735-3201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | BL04-03274
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License Number State | GA
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