Whalio Doctors

NPI 1104194307

Hattie Clay Oliver Pch

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Mableton, GA

Practice location

Address
418 Vinings Vintage Cir, Mableton, GA 30126-7208
Phone
(770) 575-0582
Fax
(404) 756-4894
Mailing address
1180 Madison Green Ln SW, Mableton, GA 30126-2154

Authorised official

Name
James C Ford
Title
Ceo
Phone
(770) 575-0582

Registered specialties (2)

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary
Residential Treatment Facilities Taxonomy 320600000X Licence PCH005570 (GA)
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Residential Treatment Facilities Taxonomy 320900000X Licence PCH005570 (GA)

Registry record

NPI
1104194307
Entity type
Organization
NPI issued
2 Dec 2011
Record last updated
6 Dec 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.