Provider Demographics
NPI:1588971550
Name:D & J SUPERIOR COMMUNITY LIVING
Entity type:Organization
Organization Name:D & J SUPERIOR COMMUNITY LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-905-2067
Mailing Address - Street 1:2579 PIERCE CIR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5768
Mailing Address - Country:US
Mailing Address - Phone:770-871-5630
Mailing Address - Fax:678-691-3269
Practice Address - Street 1:2579 PIERCE CIR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5768
Practice Address - Country:US
Practice Address - Phone:770-871-5630
Practice Address - Fax:678-691-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health