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General NPI Number Information
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NPI Number | 1861705329
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Entity Type | Organization
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Legal Business Name | GEORGIA CENTER FOR HEALTH, WELLNESS, AND RECOVERY INC
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Dates
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Enumeration Date | 07/26/2010
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 1500 KLONDIKE RD SW SUITE A-104
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City | CONYERS
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State | GA
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Zip | 30094-5179
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Country | US
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Telephone | 678-768-1214
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Fax | 404-484-8835
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Provider Business Mailing Address
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Address Line | 6964 HARBOR TOWN WAY
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-5467
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Country | US
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Telephone | 678-768-1214
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Fax | 404-484-8835
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Authorized Official
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Title or Position | CEO
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Name | DR. HALISI EDWARDS-STATEN
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Credential |
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Telephone | 678-768-1214
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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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