Provider Demographics
NPI:1700924750
Name:GA DEPARTMENT OF JUVENILE JUSTICE
Entity Type:Organization
Organization Name:GA DEPARTMENT OF JUVENILE JUSTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FEDERAL PROGRAMS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-508-6610
Mailing Address - Street 1:3408 COVINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1513
Mailing Address - Country:US
Mailing Address - Phone:404-508-6610
Mailing Address - Fax:404-508-5091
Practice Address - Street 1:3408 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1513
Practice Address - Country:US
Practice Address - Phone:404-508-6610
Practice Address - Fax:404-508-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children