Provider Demographics
NPI:1699841015
Name:FULTON COUNTY MHDDAD
Entity Type:Organization
Organization Name:FULTON COUNTY MHDDAD
Other - Org Name:CENTER FOR HEALTH AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LATANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-730-0239
Mailing Address - Street 1:265 BOULEVARD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1208
Mailing Address - Country:US
Mailing Address - Phone:404-730-1650
Mailing Address - Fax:
Practice Address - Street 1:265 BOULEVARD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1208
Practice Address - Country:US
Practice Address - Phone:404-730-1650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health