=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760008676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BESTWAY SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2020
-----------------------------------------------------
Last Update Date | 06/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1775 PARKER RD SE STE 210
-----------------------------------------------------
City | CONYERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30094-6654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-764-9800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2701 SAMSUM RD SW
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-5318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-301-9136
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | SHANELLE BEST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 574-301-9136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------