Organization
CHANGING LIVES AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONIAT JEMISON (OWNER)
(678) 396-1803
Entity
Organization
Contact information
Practice address
5284 FLOYD RD SW UNIT 2079, MABLETON, GA 30126-6120
(678) 396-1803
Mailing address
5284 FLOYD RD SW UNIT 2079, MABLETON, GA 30126-6120
(678) 396-1803
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
—
Other
Enumeration date
05/25/2026
Last updated
05/25/2026
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