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General NPI Number Information
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NPI Number | 1083379101
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Entity Type | Organization
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Legal Business Name | GOOD LANDING RECOVERY ATLANTA
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 2535 2ND AVENUE
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City | DACULA
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State | GA
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Zip | 30019
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Country | US
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Telephone | 770-450-6120
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Fax |
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Provider Business Mailing Address
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Address Line | 256 MCMILLAN RD
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City | DACULA
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State | GA
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Zip | 30019-2337
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Country | US
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Telephone | 904-302-3202
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. CHARLIE CAMPBELL
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Credential |
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Telephone | 904-302-3202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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