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Organization
ETERNAL IVY FOUNDATION INC.
Active
Organization
ETERNAL IVY FOUNDATION INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DJUAN WILLIAMS (OWNER)
(404) 919-8836
Entity
Organization
Contact information
Practice address
6000 STEWART PKWY UNIT 5646, DOUGLASVILLE, GA 30154-1109
(404) 919-8836
Mailing address
6000 STEWART PKWY UNIT 5646, DOUGLASVILLE, GA 30154-1109
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
05/01/2026
Last updated
05/01/2026
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