Organization
TODAY'S FAMILY TIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY DEWITT FULLER JR. M.A (COMMUNITY RESOURCE SPECIALIST)
(404) 433-0307
Entity
Organization
Contact information
Practice address
6439 BRIARWOOD CT, RIVERDALE, GA 30296-2904
(404) 433-0307
Mailing address
6439 BRIARWOOD CT, RIVERDALE, GA 30296-2904
(404) 433-0307
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
12-00036428
GA
252Y00000X
Early Intervention Provider Agency
12-00036428
GA
Other
Enumeration date
04/04/2012
Last updated
04/04/2012
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