Provider Demographics
NPI:1326550401
Name:AGATHOS PLACE, INC.
Entity Type:Organization
Organization Name:AGATHOS PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-755-6710
Mailing Address - Street 1:2714 WATERFORD CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-4413
Mailing Address - Country:US
Mailing Address - Phone:470-755-6710
Mailing Address - Fax:
Practice Address - Street 1:4595 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-4317
Practice Address - Country:US
Practice Address - Phone:470-755-6710
Practice Address - Fax:470-755-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health