MEDICARE: C&A BEHAVIORAL HEALTH CARE

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center	053532	GA

General Provider Information

NPI Number	:	1861846487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C&A BEHAVIORAL HEALTH CARE

Provider Business Mailing Address
First Line	:	4015 S COBB DR SE STE 120
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 S COBB DR SE STE 120
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:	678-701-7725
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDRO GIORGADZE
Credential	:	MD
Telephone Number	:	678-701-7725

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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