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General NPI Number Information
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NPI Number | 1992014823
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Entity Type | Organization
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Legal Business Name | GREATER ATLANTA YOUTH DEVELOPMENT CORPORATION
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 455 NORTH DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2628
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Country | US
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Telephone | 404-593-9613
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Fax | 770-975-7732
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Provider Business Mailing Address
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Address Line | 3305 ACWORTH OAKS DR NW SUITE #200-PMB#123
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City | ACWORTH
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State | GA
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Zip | 30101-6693
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Country | US
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Telephone | 404-593-9613
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Fax | 770-975-7732
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. WILLIAM JOSEPH THOMAS SR.
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Credential | BA, MA
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Telephone | 404-593-9613
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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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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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Taxonomy #3
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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