MEDICARE: COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF GA, 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	:	1790912087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY OUTREACH FOR YOUTH AND FAMILY SERVICES OF GA, LLC

Provider Business Mailing Address
First Line	:	3475 LENOX RD NE
Second Line	:	400
City	:	ATLANTA
State	:	GA
Zip	:	30326-3227
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3475 LENOX RD NE
Second Line	:	400
City	:	ATLANTA
State	:	GA
Zip	:	30326-3227
Country	:	US
Telephone Number	:	404-601-2862
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CORY TITO FRANCIS
Credential	:
Telephone Number	:	919-423-2277

Provider Enumeration Date	:	06/15/2009
Last Update Date	:	06/15/2009

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