| NPI | 1417434432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHAWNKA MADGETT Program Sponsor 678-603-1381 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2025-03-21 |