| Avita Community Partners | |
|
915 Interstate Ridge Dr Suite G Gainesville GA 30501-7076 | |
| (678) 207-1800 | |
| Not Available |
| Full Name | Avita Community Partners |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 915 Interstate Ridge Dr, Gainesville, Georgia |
| Authorized Official Name and Position | Karen Tucker (BILLING MANAGER) |
| Authorized Official Contact | 6785135700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avita Community Partners 4331 Thurmon Tanner Rd Flowery Branch GA 30542-2829 Ph: (678) 513-5700 | Avita Community Partners 915 Interstate Ridge Dr Suite G Gainesville GA 30501-7076 Ph: (678) 207-1800 |
| NPI Number | 1245472281 |
|---|---|
| Provider Enumeration Date | 04/06/2009 |
| Last Update Date | 04/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245472281 | NPI | - | NPPES |
| 1114988268 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC005387 (Georgia) | Primary |
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