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General NPI Number Information
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NPI Number | 1043386436
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Entity Type | Organization
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Legal Business Name | FULTON COUNTY MHDDAD
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 186 SUNSET AVENUE, NW
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City | ATLANTA
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State | GA
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Zip | 30314-4059
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Country | US
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Telephone | 404-612-9328
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Fax |
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Provider Business Mailing Address
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Address Line | 99 JESSE HILL JR DRIVE SUITE 402
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City | ATLANTA
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State | GA
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Zip | 30303-3045
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Country | US
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Telephone | 404-730-1059
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Fax | 404-730-1233
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Authorized Official
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Title or Position | HEALTH PROGRAM ADMINISTRATOR
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Name | MS. LINDA JEFFERSON
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Credential |
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Telephone | 404-730-1059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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