MEDICARE: RJ SHEPHERD II 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

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	:	1164666004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RJ SHEPHERD II INC

Provider Business Mailing Address
First Line	:	1350 DRESDEN DR NE
Second Line	:	SUITE 100
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3454
Country	:	US
Telephone Number	:	678-547-0495
Fax Number	:	678-990-0814

Provider Business Practice Location Address
First Line	:	30 PERIMETER PARK DR
Second Line	:	SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30341-1334
Country	:	US
Telephone Number	:	678-547-0495
Fax Number	:	678-990-0814

Authorized Official
Title or Position	:	CEO
Name	:	MS. TERESA RENEE OWENS
Credential	:
Telephone Number	:	678-547-0495

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	06/02/2016

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