MEDICARE: AMERICAN ALTERNATIVE COURT SERVICES, LLC

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	:	1750047684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN ALTERNATIVE COURT SERVICES, LLC

Provider Business Mailing Address
First Line	:	1295 TERRELL MILL RD SE STE 104
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-9438
Country	:	US
Telephone Number	:	404-793-6838
Fax Number	:

Provider Business Practice Location Address
First Line	:	1295 TERRELL MILL RD SE STE 104
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-9438
Country	:	US
Telephone Number	:	404-793-6838
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JACQUES KHOROZIAN
Credential	:	PHD
Telephone Number	:	404-793-6838

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	11/15/2021

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