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General NPI Number Information
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NPI Number | 1982071858
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Entity Type | Organization
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Legal Business Name | WELLSPRING LIVING
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 3965 ROOSEVELT HWY
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City | ATLANTA
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State | GA
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Zip | 30349-2607
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Country | US
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Telephone | 770-631-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 860 JOHNSON FERRY RD STE 140-330
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City | ATLANTA
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State | GA
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Zip | 30342-1435
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Country | US
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Telephone | 239-410-2585
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Fax |
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Authorized Official
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Title or Position | GED COACH
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Name | MS. TIRZAH K BROWN
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Credential |
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Telephone | 239-410-2585
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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 | CCI001962
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License Number State | GA
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