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General NPI Number Information
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NPI Number | 1063603413
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Entity Type | Organization
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Legal Business Name | ABBA HOUSE HUMAN DEVELOPMENT AND RESOURCES CENTER OF GA, INC.
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 110 TASHA CIR
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City | ELLENWOOD
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State | GA
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Zip | 30294-3046
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Country | US
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Telephone | 404-867-8945
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Fax | 770-981-5070
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Provider Business Mailing Address
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Address Line | 110 TASHA CIR
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City | ELLENWOOD
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State | GA
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Zip | 30294-3046
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Country | US
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Telephone | 404-867-8945
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Fax | 770-981-5070
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | DR. ROBERT L HARRELL
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Credential | PH.D.
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Telephone | 404-867-8945
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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 | GA
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