=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184706087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OUR COMMON WELFARE,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3423 COVINGTON DR SUITE E
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30032-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-284-9878
-----------------------------------------------------
Fax | 404-284-9972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3423 COVINGTON DR SUITE B
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30032-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-284-6061
-----------------------------------------------------
Fax | 404-284-9972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. PATRICIA BROWN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-284-6061
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------