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General NPI Number Information
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NPI Number | 1609276856
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Entity Type | Organization
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Legal Business Name | GEORGIA DETOX AND RECOVERY, LLC
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 07/28/2017
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD SE BLDG 28, STE 100
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City | MARIETTA
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State | GA
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Zip | 30067-5491
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Country | US
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Telephone | 404-941-8993
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 WINDY RIDGE PARKWAY SUITE 210S
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City | ATLANTA
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State | GA
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Zip | 30339
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Country | US
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Telephone | 470-440-1647
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Fax |
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Authorized Official
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Title or Position | VP OF REVENUE CYCLE
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Name | DEBRA TOWNSEND
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Credential | MPH, MBA
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Telephone | 470-440-1647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 033-251-D
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License Number State | GA
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