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General NPI Number Information
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NPI Number | 1063229557
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Entity Type | Organization
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Legal Business Name | RADIANT RECOVERY GEORGIA LLC
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2654 SUMMIT PKWY SW
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City | ATLANTA
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State | GA
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Zip | 30331-9425
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Country | US
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Telephone | 770-547-2958
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Fax |
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Provider Business Mailing Address
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Address Line | 2654 SUMMIT PKWY SW
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City | ATLANTA
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State | GA
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Zip | 30331-9425
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Country | US
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Telephone | 770-547-2958
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTIAN ALEXANDER JONES
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Credential |
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Telephone | 770-547-2958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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