Organization
HICKORY LOG VOCATIONAL SCHOOL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN BRIAN BARNES REV,DR (EXECUTIVE DIRECTOR)
(770) 382-6655
Entity
Organization
Contact information
Practice address
3680 HIGHWAY 411 NE, WHITE, GA 30184-2427
(770) 382-6655
Mailing address
3680 HIGHWAY 411 NE # PO300, WHITE, GA 30184-2427
(770) 382-6655
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/28/2020
Last updated
10/28/2020
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