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General NPI Number Information
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NPI Number | 1992209811
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Entity Type | Organization
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Legal Business Name | GOOD LANDING RECOVERY, CORPORATION
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Dates
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Enumeration Date | 03/23/2018
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Last Update Date | 03/23/2018
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Provider Practice Location Address
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Address Line | 256 MCMILLAN RD STE B
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City | DACULA
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State | GA
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Zip | 30019-2337
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Country | US
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Telephone | 770-570-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 3437 SANDY BANK DR
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City | AUBURN
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State | GA
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Zip | 30011-4679
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Country | US
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Telephone | 770-570-7422
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. ROBERT PEARSON LEWIS III
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Credential |
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Telephone | 770-570-7422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LPC005933
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License Number State | GA
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