MEDICARE: ACHOR CENTER, 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
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1265732127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHOR CENTER, INC.

Provider Business Mailing Address
First Line	:	180 PEYTON PL SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-1616
Country	:	US
Telephone Number	:	404-699-5657
Fax Number	:	404-699-5965

Provider Business Practice Location Address
First Line	:	180 PEYTON PL SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-1616
Country	:	US
Telephone Number	:	404-699-5657
Fax Number	:	404-699-5965

Authorized Official
Title or Position	:	BOARD CHAIR
Name	:	MR. WALTER CALLOWAY
Credential	:
Telephone Number	:	404-699-5657

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/26/2010

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