Organization
UNIQUE DESTINY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDTRICE RUSSELL (CLINICIAN)
(404) 924-5560
Entity
Organization
Contact information
Practice address
7117 WALTON HL, FAIRBURN, GA 30213-7112
(404) 924-5560
Mailing address
203 VINE ST, LAGRANGE, GA 30241-3346
(404) 924-5560
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
APC004555
GA
Other
Enumeration date
10/25/2016
Last updated
10/25/2016
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