Provider Demographics
NPI:1588215610
Name:BUSINESS & TECHNOLOGY OUTREACH CORPORATION
Entity Type:Organization
Organization Name:BUSINESS & TECHNOLOGY OUTREACH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-961-1997
Mailing Address - Street 1:PO BOX 870006
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30287-0006
Mailing Address - Country:US
Mailing Address - Phone:770-961-1997
Mailing Address - Fax:
Practice Address - Street 1:409 ARROWHEAD BLVD STE C1&C2
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1255
Practice Address - Country:US
Practice Address - Phone:770-961-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251J00000XAgenciesNursing Care
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental