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General NPI Number Information
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NPI Number | 1790912087
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Entity Type | Organization
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Legal Business Name | COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF GA, LLC
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 06/15/2009
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Provider Practice Location Address
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Address Line | 3475 LENOX RD NE 400
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City | ATLANTA
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State | GA
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Zip | 30326-3227
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Country | US
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Telephone | 404-601-2862
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Fax |
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Provider Business Mailing Address
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Address Line | 3475 LENOX RD NE 400
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City | ATLANTA
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State | GA
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Zip | 30326-3227
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CORY TITO FRANCIS
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Credential |
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Telephone | 919-423-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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