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NPI Code Detail

MEDICARE: AVA FAMILY SERVICES, LLC

MEDICARE: AVA FAMILY 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)MS
2251J00000XNursing Care Agency

General Provider Information

NPI Number : 1881102408
Entity Type Code : Organization
Provider Name (Legal Business Name) : AVA FAMILY SERVICES, LLC
Provider Business Mailing Address
First Line : 3455 PEACHTREE RD NE STE 500A
Second Line :
City : ATLANTA
State : GA
Zip : 30326-3254
Country : US
Telephone Number : 404-354-4388
Fax Number :
Provider Business Practice Location Address
First Line : 3455 PEACHTREE RD NE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30326-3236
Country : US
Telephone Number : 404-354-4388
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : DWAYNE GRAY
Credential :
Telephone Number : 919-454-1672
Provider Enumeration Date : 01/17/2018
Last Update Date : 05/23/2025

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Directions to “AVA FAMILY SERVICES, LLC ” Practice Location

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