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General NPI Number Information
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NPI Number | 1598005829
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Entity Type | Organization
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Legal Business Name | GEORGIA HEALTH ASSOCIATES
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Dates
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Enumeration Date | 02/23/2013
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Last Update Date | 02/23/2013
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Provider Practice Location Address
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Address Line | 127 PEACHTREE ST NE SUITE 720
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City | ATLANTA
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State | GA
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Zip | 30303-1810
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Country | US
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Telephone | 404-490-4128
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Fax |
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Provider Business Mailing Address
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Address Line | 127 PEACHTREE ST NE SUITE 720
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City | ATLANTA
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State | GA
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Zip | 30303-1810
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Country | US
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Telephone | 404-490-4128
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | HOLLY MIMS
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Credential | LPC
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Telephone | 404-824-7880
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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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