Provider Demographics
NPI:1831558931
Name:PERSONAL RECOVERY NETWORK LLC
Entity type:Organization
Organization Name:PERSONAL RECOVERY NETWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICHOLS
Authorized Official - Last Name:TAGTACHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-548-2589
Mailing Address - Street 1:1640 POWERS FERRY RD SE
Mailing Address - Street 2:BLDG 9 SUITE 330
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5491
Mailing Address - Country:US
Mailing Address - Phone:678-831-0608
Mailing Address - Fax:678-831-0564
Practice Address - Street 1:1640 POWERS FERRY RD SE
Practice Address - Street 2:BLDG 9 SUITE 330
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:678-831-0608
Practice Address - Fax:678-831-0564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONAL RECOVERY NETWORK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-17
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty