Provider Demographics
NPI:1881991404
Name:A HEALING PARADIGM LLC
Entity type:Organization
Organization Name:A HEALING PARADIGM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TAIWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-671-9213
Mailing Address - Street 1:950 DANNON VW SW
Mailing Address - Street 2:SUITE 4201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-2160
Mailing Address - Country:US
Mailing Address - Phone:404-635-6021
Mailing Address - Fax:404-601-7347
Practice Address - Street 1:950 DANNON VW SW
Practice Address - Street 2:SUITE 4201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2160
Practice Address - Country:US
Practice Address - Phone:404-635-6021
Practice Address - Fax:404-601-7347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003437103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA708181433AMedicaid