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General NPI Number Information
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NPI Number | 1588971550
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Entity Type | Organization
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Legal Business Name | D & J SUPERIOR COMMUNITY LIVING
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 09/10/2010
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Provider Practice Location Address
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Address Line | 2579 PIERCE CIR
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City | SNELLVILLE
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State | GA
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Zip | 30078-5768
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Country | US
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Telephone | 770-871-5630
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Fax | 678-691-3269
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Provider Business Mailing Address
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Address Line | 2579 PIERCE CIR
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City | SNELLVILLE
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State | GA
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Zip | 30078-5768
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Country | US
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Telephone | 770-871-5630
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Fax | 678-691-3269
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHAWN GRADY
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Credential |
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Telephone | 770-905-2067
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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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