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General NPI Number Information
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NPI Number | 1144972357
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Entity Type | Organization
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Legal Business Name | GREENLEAF OUTREACH SERVICES
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 12461 VETERANS MEMORIAL HWY STE 778
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2025
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Country | US
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Telephone | 470-977-2747
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Fax | 472-427-5443
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Provider Business Mailing Address
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Address Line | 12461 VETERANS MEMORIAL HWY STE 778
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2025
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Country | US
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Telephone | 470-977-2747
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Fax | 470-427-5443
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Authorized Official
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Title or Position | DIRECTOR
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Name | NATYSHIA SMITH
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Credential | MSW
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Telephone | 470-977-2747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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