Provider Demographics
NPI:1356602171
Name:THE MARY TIPTON FOUNDATION
Entity type:Organization
Organization Name:THE MARY TIPTON FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:678-302-1945
Mailing Address - Street 1:3103 CLAIRMONT RD NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1043
Mailing Address - Country:US
Mailing Address - Phone:678-302-1950
Mailing Address - Fax:404-601-1386
Practice Address - Street 1:3103 CLAIRMONT RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-1043
Practice Address - Country:US
Practice Address - Phone:678-302-1950
Practice Address - Fax:404-601-1386
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MARY TIPTON FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service