MEDICARE: GEORGIA THERAPY ASSOCIATES

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	261QM2800X	Methadone Clinic	NTP001009	GA

General Provider Information

NPI Number	:	1750414439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA THERAPY ASSOCIATES

Provider Business Mailing Address
First Line	:	2797 CAMPBELLTON RD SW
Second Line	:	SUITE C-3
City	:	ATLANTA
State	:	GA
Zip	:	30311-4455
Country	:	US
Telephone Number	:	404-349-6655
Fax Number	:	404-349-0033

Provider Business Practice Location Address
First Line	:	2797 CAMPBELLTON RD SW
Second Line	:	SUITE C-3
City	:	ATLANTA
State	:	GA
Zip	:	30311-4455
Country	:	US
Telephone Number	:	404-349-6655
Fax Number	:	404-349-0033

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. TERRY L WILLIS
Credential	:	M.S., CAS
Telephone Number	:	404-349-6655

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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