Creekside Recovery Residences, LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

CREEKSIDE RECOVERY RESIDENCES, LLC

Practice address

2940 Mabry Rd NE
Brookhaven, GA 30319-2605

Phone

(404) 333-2277

NPI assigned

Dec 3, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Carter Pope Jr.

Title

Ceo

Phone

(404) 333-2277

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1606953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1043815202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2940 MABRY RD NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303192605",
            "telephone_number": "404-333-2277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2940 MABRY RD NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303192605",
            "telephone_number": "404-333-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE RECOVERY RESIDENCES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-03",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "POPE",
        "authorized_official_first_name": "CARTER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "404-333-2277",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juliser Coston, RBT
• Raeanna Elaine Cotto, BA
• Stanley Covington Cox Jr., D.M.D., M.S.
• Jamia Craft, RBT
• Zachary Thomas Crawford, MD, PHARMD
• Jennifer Joy Crooks, FNP-BC
• Sharron Lashawn Cross, LPC
• Jesse Crowell, RBT
• Kiara Crumble, RBT
• Sigourne Latashia Crumby

• Case Management Agency in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Case Management Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; 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.