Provider Demographics
NPI:1699220475
Name:ACCESS HEALTH TREATMENT CENTER LLC
Entity type:Organization
Organization Name:ACCESS HEALTH TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:INDIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-742-3846
Mailing Address - Street 1:PO BOX 374102
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30037-4102
Mailing Address - Country:US
Mailing Address - Phone:770-742-3846
Mailing Address - Fax:770-742-3855
Practice Address - Street 1:105 BRADFORD SQ
Practice Address - Street 2:SUITE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-1974
Practice Address - Country:US
Practice Address - Phone:770-742-3846
Practice Address - Fax:770-742-3855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone