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General NPI Number Information
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NPI Number | 1700924750
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Entity Type | Organization
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Legal Business Name | GA DEPARTMENT OF JUVENILE JUSTICE
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3408 COVINGTON HWY
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City | DECATUR
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State | GA
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Zip | 30032-1513
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Country | US
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Telephone | 404-508-6610
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Fax | 404-508-5091
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Provider Business Mailing Address
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Address Line | 3408 COVINGTON HWY
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City | DECATUR
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State | GA
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Zip | 30032-1513
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Country | US
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Telephone | 404-508-6610
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Fax | 404-508-5091
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Authorized Official
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Title or Position | FEDERAL PROGRAMS DIRECTOR
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Name | MS. SANDRA DEATON
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Credential |
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Telephone | 404-508-6610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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