| Family 360 Incorporated | |
|
2215 Exchange Pl Se Ste A Conyers GA 30013-6723 | |
| (770) 679-0586 | |
| (770) 554-9349 |
| Full Name | Family 360 Incorporated |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2215 Exchange Pl Se Ste A, Conyers, Georgia |
| Authorized Official Name and Position | Desmond Orville Maul (OWNER) |
| Authorized Official Contact | 7706790586 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family 360 Incorporated 2215 Exchange Pl Se Ste A Conyers GA 30013-6723 Ph: (770) 679-0586 | Family 360 Incorporated 2215 Exchange Pl Se Ste A Conyers GA 30013-6723 Ph: (770) 679-0586 |
| NPI Number | 1003113184 |
|---|---|
| Provider Enumeration Date | 02/25/2011 |
| Last Update Date | 02/07/2024 |
| Certification Date | 11/19/2020 |
| Medicare PECOS PAC ID | 8426497009 |
|---|---|
| Medicare Enrollment ID | O20240416000339 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003113184 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | MFT 001191 (Georgia) | Primary |
| Provider Name | Desmond Orville Maul |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1841354768 PECOS PAC ID: 8325399843 Enrollment ID: I20240416000451 |
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