| Chris 180, Inc. | |
|
3700 Martin Luther King Dr Sw Atlanta GA 30331-3674 | |
| (404) 486-9034 | |
| (404) 835-9350 |
| Full Name | Chris 180, Inc. |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3700 Martin Luther King Dr Sw, Atlanta, Georgia |
| Authorized Official Name and Position | Dan James Bellor (CLINIC ADMINSITRATOR) |
| Authorized Official Contact | 4044869034 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chris 180, Inc. 1017 Fayetteville Rd Se Atlanta GA 30316-2932 Ph: (404) 486-9034 | Chris 180, Inc. 3700 Martin Luther King Dr Sw Atlanta GA 30331-3674 Ph: (404) 486-9034 |
| NPI Number | 1003377086 |
|---|---|
| Provider Enumeration Date | 03/30/2019 |
| Last Update Date | 06/11/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003377086 | NPI | - | NPPES |
| 300023628A | Medicaid | GA | |
| 640804505K | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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