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General NPI Number Information
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NPI Number | 1073786976
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Entity Type | Organization
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Legal Business Name | FRONTLINE MINISTRIES
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 2594 HIGHWAY 34 EAST SUITE B
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City | NEWNAN
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State | GA
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Zip | 30265
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Country | US
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Telephone | 770-252-3760
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Fax | 678-298-7637
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Provider Business Mailing Address
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Address Line | 2594 HIGHWAY 34 EAST SUITE B
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City | NEWNAN
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State | GA
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Zip | 30265
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Country | US
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Telephone | 770-252-3760
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Fax | 678-298-7637
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. C. STEVEN SHAFFER
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Credential | M.A., M.S., LAPC
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Telephone | 770-252-3760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW001341
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License Number State | GA
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