Organization
JIMMY'S MAGNOLIA TREE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JAN N TROTTER (DIRECTOR)
(404) 748-9276
Entity
Organization
Contact information
Practice address
1526 WESTWOOD AVE SW, ATLANTA, GA 30310-2316
(404) 748-9276
(404) 941-7929
Mailing address
1526 WESTWOOD AVE SW, ATLANTA, GA 30310-2316
(404) 748-9276
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
CLA001050
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
972175212A
COMP WAVIER
GA
Enumeration date
09/16/2013
Last updated
09/16/2013
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