Provider Demographics
NPI:1285700682
Name:FULTON COUNTY MHDDAD
Entity type:Organization
Organization Name:FULTON COUNTY MHDDAD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HR SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LATANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-730-0239
Mailing Address - Street 1:475 FAIRBURN RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-1907
Mailing Address - Country:US
Mailing Address - Phone:404-691-9627
Mailing Address - Fax:
Practice Address - Street 1:475 FAIRBURN RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-1907
Practice Address - Country:US
Practice Address - Phone:404-691-9627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health