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General NPI Number Information
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NPI Number | 1285175612
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Entity Type | Organization
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Legal Business Name | OCEANS GATE CARE LLC
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Dates
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Enumeration Date | 03/18/2017
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 1075 PEACHTREE ST NE SUITE 3650
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City | ATLANTA
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State | GA
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Zip | 30309-3912
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Country | US
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Telephone | 404-220-9263
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 54632
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City | ATLANTA
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State | GA
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Zip | 30308-0632
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Country | US
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Telephone | 404-220-9263
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEVON JOHNSON
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Credential |
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Telephone | 404-220-9263
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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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