Provider Demographics
NPI:1124174974
Name:COLLEGE PARK REGIONAL HEALTH CENTER
Entity type:Organization
Organization Name:COLLEGE PARK REGIONAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:404-730-1202
Mailing Address - Street 1:99 JESSE HILL JR. DRIVE
Mailing Address - Street 2:ROOM 402
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-730-1217
Mailing Address - Fax:404-730-1233
Practice Address - Street 1:1920 JOHN WESLEY AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-3606
Practice Address - Country:US
Practice Address - Phone:404-765-4155
Practice Address - Fax:404-765-4149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULTON COUNTY DEPT OF HEALTH&WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-26
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000051884GMedicaid
GA000698662DMedicaid
GA000457773GMedicaid
GA000457773SMedicaid