Provider Demographics
NPI:1376879577
Name:SEA JOY FAMILY SERVICE
Entity Type:Organization
Organization Name:SEA JOY FAMILY SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-374-7268
Mailing Address - Street 1:2851 CANDLER RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2851 CANDLER RD
Practice Address - Street 2:SUITE 205
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-1416
Practice Address - Country:US
Practice Address - Phone:770-374-7268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA926894182A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA926894182AMedicaid