Provider Demographics
NPI:1750611307
Name:SUPERIOR HEALTHCARE OF GEORGIA, INC
Entity type:Organization
Organization Name:SUPERIOR HEALTHCARE OF GEORGIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-563-6262
Mailing Address - Street 1:778 RAYS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3107
Mailing Address - Country:US
Mailing Address - Phone:704-563-6262
Mailing Address - Fax:704-363-6136
Practice Address - Street 1:778 RAYS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3107
Practice Address - Country:US
Practice Address - Phone:704-563-6262
Practice Address - Fax:704-363-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health