Provider Demographics
NPI:1992014823
Name:GREATER ATLANTA YOUTH DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:GREATER ATLANTA YOUTH DEVELOPMENT CORPORATION
Other - Org Name:GAYDC
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:BA, MA
Authorized Official - Phone:404-593-9613
Mailing Address - Street 1:3305 ACWORTH OAKS DR NW
Mailing Address - Street 2:SUITE #200-PMB#123
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6693
Mailing Address - Country:US
Mailing Address - Phone:404-593-9613
Mailing Address - Fax:770-975-7732
Practice Address - Street 1:455 NORTH DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2628
Practice Address - Country:US
Practice Address - Phone:404-593-9613
Practice Address - Fax:770-975-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency