Provider Demographics
NPI:1457902041
Name:SOUTHEAST ADDICTION CENTER
Entity Type:Organization
Organization Name:SOUTHEAST ADDICTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMANTIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-324-8872
Mailing Address - Street 1:3020 HOLCOMB BRIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3260 POINTE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3330
Practice Address - Country:US
Practice Address - Phone:770-217-7832
Practice Address - Fax:678-623-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility