Organization
AVITA COMMUNITY PARTNER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS SILLS LPC (SSP1)
(706) 864-6822
Entity
Organization
Contact information
Practice address
150A JOHNSON ST, DAHLONEGA, GA 30533-0501
(706) 864-6822
Mailing address
4331 THURMON TANNER RD, FLOWERY BRANCH, GA 30542-2829
(678) 513-5700
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/10/2009
Last updated
04/10/2009
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