MEDICARE: GEORGIA PARENT SUPPORT NETWORK, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	251S00000X	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063564722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA PARENT SUPPORT NETWORK, INC.

Provider Business Mailing Address
First Line	:	1381 METROPOLITAN PKWY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-4455
Country	:	US
Telephone Number	:	404-758-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1395 METROPOLITAN PKWY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-4455
Country	:	US
Telephone Number	:	404-756-8525
Fax Number	:

Authorized Official
Title or Position	:	CO-CEO
Name	:	MRS. SUE SMITH
Credential	:	PH.D.
Telephone Number	:	404-758-4500

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	08/22/2020

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