1891143244 NPI number — CHOICES BEHAVIORAL ALTERNATIVES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891143244 NPI number — CHOICES BEHAVIORAL ALTERNATIVES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICES BEHAVIORAL ALTERNATIVES
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:
1891143244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1495 WATERCOVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30043-7041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-681-2303
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4037 DARLING COURT
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LILBURN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-681-2303
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WYATT
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-681-2303

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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