Provider Demographics
NPI:1376099069
Name:TORY BOGER
Entity Type:Organization
Organization Name:TORY BOGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARA-PROFESSIONAL
Authorized Official - Prefix:
Authorized Official - First Name:TORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-346-5566
Mailing Address - Street 1:2202 TREE CORNERS PKWY
Mailing Address - Street 2:2202 TREE CORNERS PKWY
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-3134
Mailing Address - Country:US
Mailing Address - Phone:678-346-5566
Mailing Address - Fax:
Practice Address - Street 1:2202 TREE CORNERS PKWY
Practice Address - Street 2:2202 TREE CORNERS PKWY
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3134
Practice Address - Country:US
Practice Address - Phone:678-346-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health