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General NPI Number Information
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NPI Number | 1548449242
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Entity Type | Organization
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Legal Business Name | BESIDE STILL WATERS, INC
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 777 CLEVELAND AVE SW SUITE 212
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City | ATLANTA
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State | GA
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Zip | 30315-7129
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Country | US
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Telephone | 404-761-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 777 CLEVELAND AVE SW SUITE 212
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City | ATLANTA
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State | GA
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Zip | 30315-7129
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Country | US
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Telephone | 404-761-3500
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TROY D ROLLINS
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Credential | MS; MBA
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Telephone | 404-761-3500
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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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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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