MEDICARE: POSITIVE TRANSITION SERVICE 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

General Provider Information

NPI Number	:	1235847542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE TRANSITION SERVICE INC

Provider Business Mailing Address
First Line	:	3645 MARKETPLACE BLVD STE 130-546
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-5747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3480 GREENBRIAR PKWY SW STE 216
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3126
Country	:	US
Telephone Number	:	678-298-6140
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BARTOLA ANDERSON
Credential	:
Telephone Number	:	770-374-9664

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	02/27/2024

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