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General NPI Number Information
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NPI Number | 1043544968
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Entity Type | Organization
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Legal Business Name | GA CHAMPION PROJECT INC
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 7651 TARA BLVD SUITE 2000
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City | JONESBORO
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State | GA
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Zip | 30236-7322
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Country | US
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Telephone | 770-210-8484
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Fax |
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Provider Business Mailing Address
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Address Line | 7651 TARA BLVD SUITE 2000
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City | JONESBORO
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State | GA
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Zip | 30236-7322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROGRAM ADMINISTRATOR
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Name | MR. MICHAEL WINFREE
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Credential |
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Telephone | 770-413-1690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0000000000
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License Number State | GA
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