| Shallowford Group Home | |
|
2473 Shallowford Rd Ne Atlanta GA 30345-1363 | |
| (404) 636-0955 | |
| (404) 636-0955 |
| Full Name | Shallowford Group Home |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2473 Shallowford Rd Ne, Atlanta, Georgia |
| Authorized Official Name and Position | Fabio Bruno Van Der Merwe (COO) |
| Authorized Official Contact | 4042943836 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shallowford Group Home 445 Winn Way Fl 4 Decatur GA 30030-1707 Ph: (404) 508-7796 | Shallowford Group Home 2473 Shallowford Rd Ne Atlanta GA 30345-1363 Ph: (404) 636-0955 |
| NPI Number | 1306981113 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 08/19/2024 |
| Certification Date | 08/19/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306981113 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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