Provider Demographics
NPI:1386964690
Name:POTTERS HANDS INSTITUTE LLC
Entity type:Organization
Organization Name:POTTERS HANDS INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOBOLAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:OYEBANJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-459-8799
Mailing Address - Street 1:307 OLD STONE RD
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1214
Mailing Address - Country:US
Mailing Address - Phone:770-459-8799
Mailing Address - Fax:770-459-8919
Practice Address - Street 1:307 OLD STONE RD
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1214
Practice Address - Country:US
Practice Address - Phone:770-459-8799
Practice Address - Fax:770-459-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADRUG000750261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder