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General NPI Number Information
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NPI Number | 1477747244
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Entity Type | Organization
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Legal Business Name | DIVINITY SENTIMENTS INC
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 04/30/2008
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Provider Practice Location Address
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Address Line | 4328 CLEVEMONT RD
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City | ELLENWOOD
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State | GA
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Zip | 30294-1329
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Country | US
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Telephone | 404-212-9666
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Fax |
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Provider Business Mailing Address
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Address Line | 1064 ROWANSHYRE CIR
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City | MCDONOUGH
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State | GA
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Zip | 30253-2917
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Country | US
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Telephone | 770-898-3002
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. DENISE D GATEWOOD
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Credential | BBA
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Telephone | 770-898-3002
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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 | 000723
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License Number State | GA
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