Organization
EGO IDEAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES L MILLER (CFO)
(678) 705-9527
Entity
Organization
Contact information
Practice address
4484 COVINGTON HWY, DECATUR, GA 30035-1203
(678) 705-9527
Mailing address
3574 COLUMBIA PKWY, DECATUR, GA 30034-3349
(678) 705-9527
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
305S00000X
Point of Service
—
—
Other
Enumeration date
05/02/2019
Last updated
05/02/2019
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