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804 Commerce Blvd Suite A2 Riverdale GA 30296-7198 | |
| (678) 479-7040 | |
| (678) 731-1552 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 804 Commerce Blvd, Riverdale, Georgia |
| Authorized Official Name and Position | Keith Thompson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6787773635 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 741207 Riverdale GA 30274-1319 Ph: (678) 479-7040 | 804 Commerce Blvd Suite A2 Riverdale GA 30296-7198 Ph: (678) 479-7040 |
| NPI Number | 1730361775 |
|---|---|
| Provider Enumeration Date | 12/01/2007 |
| Last Update Date | 12/01/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730361775 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Georgia) | Primary |
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