| NPI | 1407112360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY DEWITT FULLER Community Resource Specialist 404-433-0307 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: GA 12-00036428) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: GA 12-00036428) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2012-04-04 |