Provider Demographics
NPI:1043544968
Name:GA CHAMPION PROJECT INC
Entity Type:Organization
Organization Name:GA CHAMPION PROJECT INC
Other - Org Name:NA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-413-1690
Mailing Address - Street 1:7651 TARA BLVD
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-7322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7651 TARA BLVD
Practice Address - Street 2:SUITE 2000
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-7322
Practice Address - Country:US
Practice Address - Phone:770-210-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000000000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty