Provider Demographics
NPI:1043549686
Name:NORTH GEORGIA CHILDREN'S CENTER, INC.
Entity Type:Organization
Organization Name:NORTH GEORGIA CHILDREN'S CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:770-844-8664
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-0038
Mailing Address - Country:US
Mailing Address - Phone:770-844-8664
Mailing Address - Fax:770-844-8643
Practice Address - Street 1:1575 DAHLONEGA HWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-4528
Practice Address - Country:US
Practice Address - Phone:770-844-8664
Practice Address - Fax:770-844-8643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty