Provider Demographics
NPI:1093868903
Name:MEDLIN TREATMENT CENTER INC
Entity Type:Organization
Organization Name:MEDLIN TREATMENT CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:JERNIGAN
Authorized Official - Last Name:HALL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:770-507-6044
Mailing Address - Street 1:110 EAGLES WALK
Mailing Address - Street 2:STE. 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7204
Mailing Address - Country:US
Mailing Address - Phone:770-507-6044
Mailing Address - Fax:770-507-5284
Practice Address - Street 1:110 EAGLES WALK
Practice Address - Street 2:STE. 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7204
Practice Address - Country:US
Practice Address - Phone:770-507-6044
Practice Address - Fax:770-507-5284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty