MEDICARE: ADDICTION TREATMENT CENTER OF ATLANTA 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	207QA0401X	Addiction Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1992400204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION TREATMENT CENTER OF ATLANTA LLC

Provider Business Mailing Address
First Line	:	6380 BELLS FERRY RD STE 107
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30102-5435
Country	:	US
Telephone Number	:	678-702-4488
Fax Number	:

Provider Business Practice Location Address
First Line	:	6380 BELLS FERRY RD STE 107
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30102-5435
Country	:	US
Telephone Number	:	678-787-2776
Fax Number	:	678-285-5598

Authorized Official
Title or Position	:	MD
Name	:	AJIBOLA BABATUNDE
Credential	:
Telephone Number	:	678-702-4488

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	02/26/2025

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