Organization
FRAGMENTS MINISTRY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD LEON CLOUD (D.O.)
(678) 598-0651
Entity
Organization
Contact information
Practice address
635 PEARCE ST SW, ATLANTA, GA 30310-2829
(404) 735-3237
Mailing address
5793 JAMES RD, AUSTELL, GA 30168-4505
(678) 598-0378
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
—
GA
347B00000X
Bus
Primary
—
GA
Other
Enumeration date
09/05/2012
Last updated
09/05/2012
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