Provider Demographics
NPI:1992400204
Name:ADDICTION TREATMENT CENTER OF ATLANTA LLC
Entity type:Organization
Organization Name:ADDICTION TREATMENT CENTER OF ATLANTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AJIBOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABATUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-702-4488
Mailing Address - Street 1:6380 BELLS FERRY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-5435
Mailing Address - Country:US
Mailing Address - Phone:678-702-4488
Mailing Address - Fax:
Practice Address - Street 1:6380 BELLS FERRY RD STE 107
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-5435
Practice Address - Country:US
Practice Address - Phone:678-787-2776
Practice Address - Fax:678-285-5598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty