Provider Demographics
NPI:1679671507
Name:GEORGIA FAMILY SUPPORT SYSTEMS, INC.
Entity Type:Organization
Organization Name:GEORGIA FAMILY SUPPORT SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR AND CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PATILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, SAM
Authorized Official - Phone:678-479-3505
Mailing Address - Street 1:194 JONESBORO RD STE K
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4813
Mailing Address - Country:US
Mailing Address - Phone:678-479-3505
Mailing Address - Fax:770-471-4595
Practice Address - Street 1:194 JONESBORO RD STE K
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4813
Practice Address - Country:US
Practice Address - Phone:678-479-3505
Practice Address - Fax:770-471-4595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004196251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management