Provider Demographics
NPI:1942820329
Name:TARGET MANAGEMENT
Entity Type:Organization
Organization Name:TARGET MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:AHMOSE
Authorized Official - Middle Name:AMEXEM
Authorized Official - Last Name:EL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-684-4470
Mailing Address - Street 1:1530 MCCONNELL RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1376
Mailing Address - Country:US
Mailing Address - Phone:917-684-4470
Mailing Address - Fax:
Practice Address - Street 1:201 WALL ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-1940
Practice Address - Country:US
Practice Address - Phone:917-684-4470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty