Provider Demographics
NPI:1164762589
Name:ATLANTA INSTITUTE FOR FAMILY STUDIES
Entity Type:Organization
Organization Name:ATLANTA INSTITUTE FOR FAMILY STUDIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-554-5414
Mailing Address - Street 1:PO BOX 1147
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-1147
Mailing Address - Country:US
Mailing Address - Phone:770-554-5414
Mailing Address - Fax:
Practice Address - Street 1:935 LOST FOREST DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-2158
Practice Address - Country:US
Practice Address - Phone:770-417-2717
Practice Address - Fax:770-466-3167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000461251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA682222414292OtherMEDICARE PTAN
68BBGHXMedicare PIN