Provider Demographics
NPI:1558691568
Name:AMERISOUTH COMMUNITY PARTNERS
Entity type:Organization
Organization Name:AMERISOUTH COMMUNITY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-777-2522
Mailing Address - Street 1:PO BOX 870167
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-0005
Mailing Address - Country:US
Mailing Address - Phone:678-777-2522
Mailing Address - Fax:404-496-6845
Practice Address - Street 1:1770 INDIAN TRAIL LILBURN RD
Practice Address - Street 2:200
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-2642
Practice Address - Country:US
Practice Address - Phone:678-777-2522
Practice Address - Fax:404-496-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health