| Side By Side Clubhouse, Inc. | |
|
1001 Main St Stone Mountain GA 30083-2922 | |
| (404) 378-1139 | |
| (404) 378-1164 |
| Full Name | Side By Side Clubhouse, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1001 Main St, Stone Mountain, Georgia |
| Authorized Official Name and Position | Cynthia Johnson (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7704699355 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Side By Side Clubhouse, Inc. 1001 Main St Stone Mountain GA 30083-2922 Ph: (770) 469-9355 | Side By Side Clubhouse, Inc. 1001 Main St Stone Mountain GA 30083-2922 Ph: (404) 378-1139 |
| NPI Number | 1275674186 |
|---|---|
| Provider Enumeration Date | 02/12/2007 |
| Last Update Date | 05/05/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275674186 | NPI | - | NPPES |
| 000877676A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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