Provider Demographics
NPI:1639422330
Name:THE SMART PLACE
Entity Type:Organization
Organization Name:THE SMART PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUNZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-469-4418
Mailing Address - Street 1:1916 GLENFAIR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1849
Mailing Address - Country:US
Mailing Address - Phone:770-469-4418
Mailing Address - Fax:770-469-4438
Practice Address - Street 1:1916 GLENFAIR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1849
Practice Address - Country:US
Practice Address - Phone:770-469-4418
Practice Address - Fax:770-469-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA031956120Medicaid