Provider Demographics
NPI:1750525275
Name:BUSINESS & TECHNOLOGY OUTREACH CORPORATION
Entity type:Organization
Organization Name:BUSINESS & TECHNOLOGY OUTREACH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-608-1101
Mailing Address - Street 1:5386 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3557
Mailing Address - Country:US
Mailing Address - Phone:404-608-1101
Mailing Address - Fax:404-608-1110
Practice Address - Street 1:5386 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3557
Practice Address - Country:US
Practice Address - Phone:404-608-1101
Practice Address - Fax:404-608-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty