| NPI | 1487799151 |
|---|---|
| Other Name | SOUTHERN AVENUE |
| Entity Type | Organization |
| Authorized Contact | JENNIFER D LOZANO Director Of Revenue Cycle 404-364-2900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2015-09-16 |