Organization
IMPACT COMMUNITY HEALTH ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. XAVIER YOUNG (CEO)
(704) 315-3895
Entity
Organization
Contact information
Practice address
3581 MAIN ST STE 103, COLLEGE PARK, GA 30337-2623
(704) 315-3895
Mailing address
1905 JOHN CALVIN AVE, COLLEGE PARK, GA 30337-2517
(704) 315-3895
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7043153895
—
GA
Enumeration date
11/12/2021
Last updated
11/12/2021
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