Provider Demographics
NPI:1821758293
Name:GREENLEAF FAMILY CENTERS INC.
Entity Type:Organization
Organization Name:GREENLEAF FAMILY CENTERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TONICA
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-317-9633
Mailing Address - Street 1:4775 JIMMY CARTER BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3760
Mailing Address - Country:US
Mailing Address - Phone:678-894-0288
Mailing Address - Fax:
Practice Address - Street 1:4775 JIMMY CARTER BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3760
Practice Address - Country:US
Practice Address - Phone:678-894-0288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center