Provider Demographics
NPI:1699132951
Name:PERSONAL RECOVERY NETWORK LLC
Entity type:Organization
Organization Name:PERSONAL RECOVERY NETWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGTACHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-548-2589
Mailing Address - Street 1:5775 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:C200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1556
Mailing Address - Country:US
Mailing Address - Phone:678-426-2930
Mailing Address - Fax:
Practice Address - Street 1:5775 PEACHTREE DUNWOODY RD
Practice Address - Street 2:C200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1556
Practice Address - Country:US
Practice Address - Phone:678-426-2930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERSONAL RECOVERY NETWORK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty