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General NPI Number Information
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NPI Number | 1487439709
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Entity Type | Organization
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Legal Business Name | GEORGIA LIFE SERVICES, INC
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Dates
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Enumeration Date | 08/25/2023
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 240 PEACHTREE ST NW BSMT BO56193
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City | ATLANTA
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State | GA
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Zip | 30303-1302
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Country | US
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Telephone | 770-744-4065
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 56193
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City | ATLANTA
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State | GA
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Zip | 30343-0193
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Country | US
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Telephone | 770-744-4065
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | RONN ROSS
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Credential |
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Telephone | 404-668-6888
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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 |
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License Number State |
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