Organization
SIDE BY SIDE CLUBHOUSE, INC.
Active
Organization
SIDE BY SIDE CLUBHOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CYNTHIA JOHNSON MA (EXECUTIVE DIRECTOR)
(770) 469-9355
Entity
Organization
Contact information
Practice address
1001 MAIN ST, STONE MOUNTAIN, GA 30083-2922
(404) 378-1139
(404) 378-1164
Mailing address
1001 MAIN ST, STONE MOUNTAIN, GA 30083-2922
(770) 469-9355
(770) 469-9385
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000877676A
—
GA
Enumeration date
02/12/2007
Last updated
05/05/2010
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