| When I Was A Child Corp | |
|
6235 Providence Club Dr Mableton GA 30126-7223 | |
| (678) 910-6888 | |
| Not Available |
| Full Name | When I Was A Child Corp |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 6235 Providence Club Dr, Mableton, Georgia |
| Authorized Official Name and Position | Amanda Ezzard (EXECUTIVE DIRCTOR) |
| Authorized Official Contact | 6789106888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| When I Was A Child Corp 388 Bullsboro Dr Newnan GA 30263-1069 Ph: (678) 910-6888 | When I Was A Child Corp 6235 Providence Club Dr Mableton GA 30126-7223 Ph: (678) 910-6888 |
| NPI Number | 1023690831 |
|---|---|
| Provider Enumeration Date | 04/22/2021 |
| Last Update Date | 04/22/2021 |
| Certification Date | 03/31/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023690831 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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