Provider Demographics
NPI:1376851584
Name:PROACTIVE MANAGEMENT CONSULTING, LLC
Entity Type:Organization
Organization Name:PROACTIVE MANAGEMENT CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-319-7468
Mailing Address - Street 1:2700 CUMBERLAND PKWY SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3321
Mailing Address - Country:US
Mailing Address - Phone:770-319-7468
Mailing Address - Fax:678-501-4943
Practice Address - Street 1:111 BRIDGEPOINT PLZ
Practice Address - Street 2:SUITE 308
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3084
Practice Address - Country:US
Practice Address - Phone:706-232-3070
Practice Address - Fax:866-416-1767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA212139205CMedicaid