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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