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General NPI Number Information
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NPI Number | 1699220475
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Entity Type | Organization
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Legal Business Name | ACCESS HEALTH TREATMENT CENTER LLC
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Dates
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Enumeration Date | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 105 BRADFORD SQ SUITE A
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City | FAYETTEVILLE
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State | GA
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Zip | 30215-1974
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Country | US
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Telephone | 770-742-3846
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Fax | 770-742-3855
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Provider Business Mailing Address
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Address Line | PO BOX 374102
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City | DECATUR
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State | GA
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Zip | 30037-4102
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Country | US
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Telephone | 770-742-3846
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Fax | 770-742-3855
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MS. INDIA C JOHNSON
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Credential |
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Telephone | 770-742-3846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State | GA
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