NPIMap

Organization Active NPI

Family 360 Incorporated

  • Marriage & Family Therapist
  • Conyers, GA
National Provider Identifier
1003113184
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
MFT 001191 Issued in GA
Legal business name
FAMILY 360 INCORPORATED
Practice address
2215 Exchange PL SE Ste a
Conyers, GA 30013-6723
Phone
(770) 679-0586
Fax
(770) 554-9349
NPI assigned
Feb 25, 2011
Last updated
Feb 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Desmond Orville MaulNPI 1841354768
Title
Owner
Phone
(770) 679-0586

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X MFT 001191 GA Primary

Addresses

Primary practice location

2215 Exchange PL SE Ste a
Conyers, GA 30013-6723

Mailing address

2215 Exchange PL SE Ste a
Conyers, GA 30013-6723
Phone (770) 679-0586

National Provider Directory

National Provider Directory

Locations

2215 Exchange Pl SE
#A
Conyers, GA 30013
Phone (770) 679-0586

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1003113184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 EXCHANGE PL SE STE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136723",
            "telephone_number": "770-679-0586",
            "fax_number": "770-285-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 EXCHANGE PL SE STE A",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300136723",
            "telephone_number": "770-679-0586",
            "fax_number": "770-554-9349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY 360 INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-25",
        "last_updated": "2024-02-07",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "MAUL",
        "authorized_official_first_name": "DESMOND",
        "authorized_official_middle_name": "ORVILLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-679-0586",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT 001191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conyers, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.