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General NPI Number Information
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NPI Number | 1942886189
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Entity Type | Organization
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Legal Business Name | HEALTHCARE AUTHORITY
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Dates
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Enumeration Date | 03/18/2021
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 141 BRIDGEMILL DR
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City | HAMPTON
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State | GA
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Zip | 30228-5536
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Country | US
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Telephone | 470-485-8337
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Fax |
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Provider Business Mailing Address
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Address Line | 922 HIGHWAY 81 E STE 348
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City | MCDONOUGH
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State | GA
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Zip | 30252-2978
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Country | US
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Telephone | 470-485-4337
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Fax |
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Authorized Official
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Title or Position | PRACTICE DIRECTOR
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Name | YAUNTE DVINE
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Credential | BILLER
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Telephone | 470-485-4337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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