Provider Demographics
NPI:1164102232
Name:POETIC-PROSE MANAGEMENT LLC
Entity Type:Organization
Organization Name:POETIC-PROSE MANAGEMENT LLC
Other - Org Name:POETIC-PROSE MANAGEMENT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER/OWER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-330-6987
Mailing Address - Street 1:PO BOX 3496
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30048-3496
Mailing Address - Country:US
Mailing Address - Phone:470-368-5033
Mailing Address - Fax:866-651-0172
Practice Address - Street 1:2195 W HIGHTOWER TRL
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-1820
Practice Address - Country:US
Practice Address - Phone:470-368-5033
Practice Address - Fax:866-651-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty