1336338714 NPI number — GEORGIA MENTAL HEALTH AND ADDICTIONS LLC

Table of content: LOANN KIM DO OTR (NPI 1134271299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336338714 NPI number — GEORGIA MENTAL HEALTH AND ADDICTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA MENTAL HEALTH AND ADDICTIONS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336338714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 N RIVER ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALHOUN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30701-9408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-602-9940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
320 N RIVER ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALHOUN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30701-9408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-602-9940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
706-602-9940

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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