Organization
DEVEREUX FOUNDATION
Active
Organization
DEVEREUX FOUNDATION
Active
Other names
Devereux Georgia Treatment Network
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO BOLIVAR JR. (EXECUTIVE DIRECTOR)
(687) 303-2669
Entity
Organization
Contact information
Practice address
1283 KENNESTONE CIR, SUITE 100, MARIETTA, GA 30066-6029
(678) 303-2705
Mailing address
1283 KENNESTONE CIR, SUITE 100, MARIETTA, GA 30066-6029
(678) 303-2705
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/30/2007
Last updated
11/30/2007
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