Provider Demographics
NPI:1437489622
Name:AVITA COMMUNITY PARTNERS
Entity Type:Organization
Organization Name:AVITA COMMUNITY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-513-5700
Mailing Address - Street 1:76 HUNT MARTIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-3694
Mailing Address - Country:US
Mailing Address - Phone:706-745-5911
Mailing Address - Fax:706-745-9620
Practice Address - Street 1:76 HUNT MARTIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3694
Practice Address - Country:US
Practice Address - Phone:706-745-5911
Practice Address - Fax:706-745-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005755251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health