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
915 INTERSTATE RIDGE DR, SUITE G, GAINESVILLE, GA 30501-7076
(678) 207-1800
Mailing address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5700
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC005387
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114988268
—
GA
Enumeration date
04/06/2009
Last updated
04/06/2009
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