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General NPI Number Information
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NPI Number | 1538336524
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Entity Type | Organization
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Legal Business Name | GWINNETT, ROCKDALE & NEWTON COMMUNITY SERVICE BOARD
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 595 OLD NORCROSS RD STE C
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7667
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Country | US
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Telephone | 770-995-6902
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Fax |
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Provider Business Mailing Address
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Address Line | 595 OLD NORCROSS RD STE C
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7667
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Country | US
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Telephone | 770-995-6902
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Fax |
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Authorized Official
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Title or Position | DAY SERVICES COORDINATOR
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Name | MS. LISA JO CALANDRINO
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Credential | M.S. M.H.P. CPRP
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Telephone | 770-995-6902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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