| Impact Community Health Organization | |
|
3581 Main St Ste 103 College Park GA 30337-2623 | |
| (704) 315-3895 | |
| Not Available |
| Full Name | Impact Community Health Organization |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3581 Main St Ste 103, College Park, Georgia |
| Authorized Official Name and Position | Xavier Young (CEO) |
| Authorized Official Contact | 7043153895 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Impact Community Health Organization 1905 John Calvin Ave College Park GA 30337-2517 Ph: (704) 315-3895 | Impact Community Health Organization 3581 Main St Ste 103 College Park GA 30337-2623 Ph: (704) 315-3895 |
| NPI Number | 1780340950 |
|---|---|
| Provider Enumeration Date | 11/12/2021 |
| Last Update Date | 11/12/2021 |
| Certification Date | 11/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780340950 | NPI | - | NPPES |
| 7043153895 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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