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Organization subpart
No

Provider details

NPI number
Authorized official
VICKIE BURROW-JOHNSON (CEO)
(770) 289-3682
Entity
Organization

Contact information

Practice address
5031 GLORE RD SW, MABLETON, GA 30126-5509
(770) 289-3682
(678) 321-1464
Mailing address
5031 GLORE RD SW, MABLETON, GA 30126-5509
(770) 289-3682
(678) 321-1464

Taxonomy

Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary

Other

Enumeration date
01/22/2016
Last updated
01/22/2016
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