MEDICARE: HEALTH EDUCATION ASSESSMENT AND LEADERSHIP 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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1215672555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTH EDUCATION ASSESSMENT AND LEADERSHIP INC

Provider Business Mailing Address
First Line	:	3915 CASCADE RD SW STE T-90
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8660
Country	:	US
Telephone Number	:	404-564-7749
Fax Number	:	404-758-1216

Provider Business Practice Location Address
First Line	:	1188 RALPH DAVID ABERNATHY BLVD SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30310-1716
Country	:	US
Telephone Number	:	404-564-7749
Fax Number	:	404-758-1216

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	MS. SHAWN L WRIGHT
Credential	:
Telephone Number	:	404-564-7749

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/02/2022

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