Organization
AVITA COMMUNITY PARTNERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN TUCKER (BILLING MANAGER)
(678) 513-5700
Entity
Organization
Contact information
Practice address
1763 FERNSIDE DR, TOCCOA, GA 30577-8095
(706) 282-4542
Mailing address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MSW004930
GA
Other
Enumeration date
02/23/2010
Last updated
02/23/2010
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