# CLUB STAFFING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639351315
- **Authorized official:** NOVELLA D TASCOE RRT (RESPIRATORY THERAPIST)
- **Authorized official phone:** (404) 840-0747

## Contact information

- **Practice address:** 5027 UPPER ELM ST, ATLANTA, GA 30349-1669
- **Practice address phone:** (404) 840-0747
- **Mailing address:** 5027 UPPER ELM ST, ATLANTA, GA 30349-1669

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | 005530 | GA | Yes |

## Other

- **Enumeration date:** 12/04/2007
- **Last updated:** 12/04/2007