Provider Demographics
NPI:1306005103
Name:FIRST VICTORY BAPTIST CHURCH
Entity Type:Organization
Organization Name:FIRST VICTORY BAPTIST CHURCH
Other - Org Name:MASON'S BOYS AND GIRLS WORLD
Other - Org Type:Other Name
Authorized Official - Title/Position:CHURCH ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WINFREE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-969-4744
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:GA
Mailing Address - Zip Code:30272-0839
Mailing Address - Country:US
Mailing Address - Phone:770-969-4744
Mailing Address - Fax:
Practice Address - Street 1:5461 STONEWALL TELL RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-2458
Practice Address - Country:US
Practice Address - Phone:770-969-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty