Provider Demographics
NPI:1134652555
Name:ADULT DAY OF DUNWOODY
Entity Type:Organization
Organization Name:ADULT DAY OF DUNWOODY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BURDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-298-9484
Mailing Address - Street 1:1 DUNWOODY PARK
Mailing Address - Street 2:SUITE 123
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7404
Mailing Address - Country:US
Mailing Address - Phone:770-551-2722
Mailing Address - Fax:770-551-2729
Practice Address - Street 1:1 DUNWOODY PARK
Practice Address - Street 2:SUITE 123
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-7404
Practice Address - Country:US
Practice Address - Phone:770-551-2722
Practice Address - Fax:770-551-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVA24716A0004OtherVA
GA003175024AMedicaid