Provider Demographics
NPI:1477230266
Name:THE SOLE CIRCLE FOUNDATION
Entity Type:Organization
Organization Name:THE SOLE CIRCLE FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:706-289-8527
Mailing Address - Street 1:9095 CAMPESTRAL CT
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6615
Mailing Address - Country:US
Mailing Address - Phone:706-289-8527
Mailing Address - Fax:
Practice Address - Street 1:106 E PONCE DE LEON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2526
Practice Address - Country:US
Practice Address - Phone:706-289-8527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service