Provider Demographics
NPI:1710288618
Name:ATLANTA INTERVENTION CENTER, INC
Entity Type:Organization
Organization Name:ATLANTA INTERVENTION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:COLQUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-914-2965
Mailing Address - Street 1:6992 TALKEETNA CT SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9480
Mailing Address - Country:US
Mailing Address - Phone:404-914-2965
Mailing Address - Fax:
Practice Address - Street 1:461 HILLSIDE DR SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-4415
Practice Address - Country:US
Practice Address - Phone:404-914-2965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health