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General NPI Number Information
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NPI Number | 1235315623
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Entity Type | Organization
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Legal Business Name | A VILLAGE@SOUTHFULTON, INC
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 3475 N DESERT DR BUILDING 100
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City | EAST POINT
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State | GA
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Zip | 30344-5723
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Country | US
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Telephone | 404-574-2440
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Fax | 404-574-2441
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Provider Business Mailing Address
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Address Line | 3475 N DESERT DR BUILDING 100
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City | EAST POINT
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State | GA
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Zip | 30344-5723
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Country | US
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Telephone | 404-574-2440
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Fax | 404-574-2441
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | BARON L. COKER
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Credential |
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Telephone | 404-574-2440
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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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