| Atlanta Detox Center, Llc | |
|
277 Medical Way Riverdale GA 30274-2522 | |
| (470) 298-7236 | |
| (470) 300-8480 |
| Full Name | Atlanta Detox Center, Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 277 Medical Way, Riverdale, Georgia |
| Authorized Official Name and Position | Jessie Costley (LICENSING AND CREDENTIALING SPECIAL) |
| Authorized Official Contact | 4108078471 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Atlanta Detox Center, Llc 277 Medical Way Riverdale GA 30274-2522 Ph: (470) 298-7236 | Atlanta Detox Center, Llc 277 Medical Way Riverdale GA 30274-2522 Ph: (470) 298-7236 |
| NPI Number | 1679155337 |
|---|---|
| Provider Enumeration Date | 04/22/2021 |
| Last Update Date | 04/22/2021 |
| Certification Date | 04/22/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679155337 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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