MEDICARE: TALBOTT RECOVERY CAMPUS

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	DRUG12459	GA

General Provider Information

NPI Number	:	1275765307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TALBOTT RECOVERY CAMPUS

Provider Business Mailing Address
First Line	:	4480 N SHALLOWFORD RD STE 224
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6410
Country	:	US
Telephone Number	:	404-952-2500
Fax Number	:	770-454-5575

Provider Business Practice Location Address
First Line	:	4480 N SHALLOWFORD RD STE 224
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6410
Country	:	US
Telephone Number	:	404-952-2500
Fax Number	:	770-454-5575

Authorized Official
Title or Position	:	SR VP CFO
Name	:	STEVE FILTON
Credential	:
Telephone Number	:	610-768-3300

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	06/11/2021

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