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General NPI Number Information
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NPI Number | 1801332150
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Entity Type | Organization
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Legal Business Name | RIVERMEND HEALTH CENTERS, LLC OF GEORGIA
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 1640 POWERS FERRY RD SE BUILDING 6, SUIET 100
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City | MARIETTA
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State | GA
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Zip | 30067-5491
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Country | US
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Telephone | 678-813-0505
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Fax | 678-813-0505
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Provider Business Mailing Address
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Address Line | 2300 WINDY RIDGE PKWY SE SUIET 210S
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City | ATLANTA
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State | GA
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Zip | 30339-5665
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Country | US
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Telephone | 678-813-0505
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Fax | 678-813-0505
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Authorized Official
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Title or Position | DIRECTOR OF RCM
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Name | TYEAST REYNOLDS
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Credential |
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Telephone | 678-813-0428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 033-421-D
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License Number State | GA
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