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General NPI Number Information
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NPI Number | 1245926427
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Entity Type | Organization
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Legal Business Name | GHM2012 CORP.
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 700 SUNSET DR STE 302
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City | ATHENS
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State | GA
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Zip | 30606-7721
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Country | US
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Telephone | 404-775-5755
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Fax |
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Provider Business Mailing Address
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Address Line | 2522 PARKSIDE DR NE
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City | ATLANTA
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State | GA
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Zip | 30305-3732
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Country | US
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Telephone | 404-775-5755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | REBECCA BLOOMFIELD KUBIN
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Credential |
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Telephone | 404-775-5755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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