Organization
AVITA COMMUNITY PARTNERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE RUTHERFORD (CEO)
(678) 513-5700
Entity
Organization
Contact information
Practice address
76 HUNT MARTIN ST, SUITE A, BLAIRSVILLE, GA 30512-3694
(706) 745-5911
(706) 745-9620
Mailing address
76 HUNT MARTIN ST, SUITE A, BLAIRSVILLE, GA 30512-3694
(706) 745-5911
(706) 745-9620
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LPC005755
GA
Other
Enumeration date
01/11/2010
Last updated
01/11/2010
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