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General NPI Number Information
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NPI Number | 1164666004
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Entity Type | Organization
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Legal Business Name | RJ SHEPHERD II INC
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 30 PERIMETER PARK DR SUITE 100
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City | ATLANTA
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State | GA
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Zip | 30341-1334
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Country | US
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Telephone | 678-547-0495
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Fax | 678-990-0814
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Provider Business Mailing Address
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Address Line | 1350 DRESDEN DR NE SUITE 100
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City | BROOKHAVEN
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State | GA
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Zip | 30319-3454
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Country | US
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Telephone | 678-547-0495
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Fax | 678-990-0814
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Authorized Official
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Title or Position | CEO
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Name | MS. TERESA RENEE OWENS
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Credential |
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Telephone | 678-547-0495
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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 |
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