Provider Demographics
NPI:1851881353
Name:ATLANTA LIFE JOURNEYS SERVICES, LLC
Entity Type:Organization
Organization Name:ATLANTA LIFE JOURNEYS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:DEAS
Authorized Official - Suffix:
Authorized Official - Credentials:IT
Authorized Official - Phone:318-436-9717
Mailing Address - Street 1:921 SECOND ST
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3017
Mailing Address - Country:US
Mailing Address - Phone:318-436-9717
Mailing Address - Fax:318-402-0913
Practice Address - Street 1:3196 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30354-1149
Practice Address - Country:US
Practice Address - Phone:813-417-6944
Practice Address - Fax:318-402-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health