| Success Dynamics Incorporated | |
|
2056 W Park Place Blvd Ste D Stone Mountain GA 30087-3537 | |
| (678) 318-3622 | |
| Not Available |
| Full Name | Success Dynamics Incorporated |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2056 W Park Place Blvd Ste D, Stone Mountain, Georgia |
| Authorized Official Name and Position | Calvin Oliver Ellison (CEO) |
| Authorized Official Contact | 2527175930 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Success Dynamics Incorporated 2056 W Park Place Blvd Ste D Stone Mountain GA 30087-3537 Ph: (678) 318-3622 | Success Dynamics Incorporated 2056 W Park Place Blvd Ste D Stone Mountain GA 30087-3537 Ph: (678) 318-3622 |
| NPI Number | 1669056313 |
|---|---|
| Provider Enumeration Date | 05/10/2021 |
| Last Update Date | 05/10/2021 |
| Certification Date | 05/10/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669056313 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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