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General NPI Number Information
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NPI Number | 1417258732
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Entity Type | Organization
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Legal Business Name | ATLEMISIA ANDERSON
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 416 GLEN ARVEN DR
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City | THOMASVILLE
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State | GA
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Zip | 31792-6837
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Country | US
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Telephone | 229-379-1007
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Fax |
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Provider Business Mailing Address
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Address Line | 117 WILLOW RIDGE CIR
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City | THOMASVILLE
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State | GA
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Zip | 31757-2834
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Country | US
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Telephone | 229-379-1007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ATLEMISIA M ANDERSON
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Credential |
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Telephone | 229-379-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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