MEDICARE: PURPLE RECOVERY CENTER FOR MEN

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	261QM0850X	Adult Mental Health Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1932906161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPLE RECOVERY CENTER FOR MEN

Provider Business Mailing Address
First Line	:	1958 CRUSE RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-2317
Country	:	US
Telephone Number	:	678-203-5507
Fax Number	:

Provider Business Practice Location Address
First Line	:	1958 CRUSE RD
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-2317
Country	:	US
Telephone Number	:	678-203-5507
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ADAM MILLER
Credential	:
Telephone Number	:	770-598-9906

Provider Enumeration Date	:	02/26/2025
Last Update Date	:	05/20/2026

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