Provider Demographics
NPI:1992087472
Name:PAULDING ENTERPRISES, INC.
Entity type:Organization
Organization Name:PAULDING ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-445-6051
Mailing Address - Street 1:110 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-3610
Mailing Address - Country:US
Mailing Address - Phone:770-445-6051
Mailing Address - Fax:770-443-2374
Practice Address - Street 1:110 STADIUM DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-3610
Practice Address - Country:US
Practice Address - Phone:770-445-6051
Practice Address - Fax:770-443-2374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000696847EMedicaid
GA000696847DMedicaid
GA000696847AMedicaid
GA000696847FMedicaid