Provider Demographics
NPI:1437299625
Name:FULTON COUNTY MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:FULTON COUNTY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:EGLEN
Authorized Official - Suffix:III
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-691-9627
Mailing Address - Street 1:475 FAIRBURN RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-1907
Mailing Address - Country:US
Mailing Address - Phone:404-691-9627
Mailing Address - Fax:404-691-9793
Practice Address - Street 1:475 FAIRBURN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-1907
Practice Address - Country:US
Practice Address - Phone:404-691-9627
Practice Address - Fax:404-691-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW003136251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health