Organization
ANOTHER CHANCE CUSTOMIZE SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANG N NDUKWE PHD (CEO)
(678) 518-1823
Entity
Organization
Contact information
Practice address
2412 PARK CENTRAL BLVD, DECATUR, GA 30035-3901
(678) 518-1823
Mailing address
2412 PARK CENTRAL BLVD, DECATUR, GA 30035-3901
(678) 518-1823
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
044-R-0675
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
690760120 B, C, D, E
—
GA
Enumeration date
09/21/2011
Last updated
09/21/2011
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