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General NPI Number Information
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NPI Number | 1972161032
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Entity Type | Organization
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Legal Business Name | REGION IV DEPARTMENT OF FAMILY AND CHILDREN SERVICES
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 242 ODELL RD STE 5
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City | GRIFFIN
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State | GA
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Zip | 30224-4879
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Country | US
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Telephone | 770-233-5523
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Fax |
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Provider Business Mailing Address
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Address Line | 242 ODELL RD STE 5
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City | GRIFFIN
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State | GA
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Zip | 30224-4879
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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 | FISCAL OPER MGR
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Name | MS. KELLY ANN PRAINO
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Credential |
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Telephone | 770-233-5523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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