Provider Demographics
NPI:1417251810
Name:PROVIDER RESOURCE SOLUTIONS OF GEORGIA, INC
Entity Type:Organization
Organization Name:PROVIDER RESOURCE SOLUTIONS OF GEORGIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-829-2715
Mailing Address - Street 1:101 BECKETT LN
Mailing Address - Street 2:SUITE 505
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7155
Mailing Address - Country:US
Mailing Address - Phone:404-829-2715
Mailing Address - Fax:
Practice Address - Street 1:101 BECKETT LN
Practice Address - Street 2:SUITE 505
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7155
Practice Address - Country:US
Practice Address - Phone:404-829-2715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services