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General NPI Number Information
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NPI Number | 1649734013
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA COMMUNITY CARE NETWORK, LTD. CO.
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 1372 PEACHTREE ST NE
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City | ATLANTA
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State | GA
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Zip | 30309-3203
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Country | US
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Telephone | 404-551-4611
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Fax | 404-551-4697
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Provider Business Mailing Address
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Address Line | 3710 GADOLINITE TRL
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City | CUMMING
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State | GA
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Zip | 30040-6181
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Country | US
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Telephone | 404-551-4611
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Fax | 404-551-4697
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MATTHEW DIXON
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Credential | , MSW, CCM
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Telephone | 404-551-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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