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General NPI Number Information
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NPI Number | 1407125388
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Entity Type | Organization
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Legal Business Name | CREEKSIDE SERVICES, LLC
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 5800 MOUNTAIN CREEK RD NE
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-5035
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Country | US
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Telephone | 404-228-6554
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Fax | 404-963-0555
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Provider Business Mailing Address
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Address Line | 5800 MOUNTAIN CREEK RD NE
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City | SANDY SPRINGS
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State | GA
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Zip | 30328-5035
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Country | US
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Telephone | 404-228-6554
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Fax | 404-963-0555
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MS. CAROL REYNOLDS
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Credential |
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Telephone | 404-786-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 39
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LMSW004998
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License Number State | GA
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