Provider Demographics
NPI:1982942934
Name:CORE HEALTH PROVIDER SERVICES, INC
Entity Type:Organization
Organization Name:CORE HEALTH PROVIDER SERVICES, INC
Other - Org Name:CORE HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-887-5083
Mailing Address - Street 1:174 THORNCLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2644
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2131 KINGSTON CT SE STE 108
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8929
Practice Address - Country:US
Practice Address - Phone:678-772-7415
Practice Address - Fax:678-804-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-26
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health