Provider Demographics
NPI:1316570534
Name:A3J INCORPORATED
Entity Type:Organization
Organization Name:A3J INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:HENNINGER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:404-576-0407
Mailing Address - Street 1:3950 COBB PKWY NW STE 305
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-9527
Mailing Address - Country:US
Mailing Address - Phone:404-576-0407
Mailing Address - Fax:
Practice Address - Street 1:3950 COBB PKWY NW STE 305
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-9527
Practice Address - Country:US
Practice Address - Phone:404-576-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
198447OtherPRIVATE