Atlanta Detox Center, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

ATLANTA DETOX CENTER, LLC

Practice address

277 Medical Way
Riverdale, GA 30274-2522

Phone

(470) 298-7236

Fax

(470) 300-8480

NPI assigned

Apr 22, 2021

Last updated

Apr 22, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

ATLANTA DETOX CENTER, LLCAs reported in NPPES

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

Authorized official

Name

Jessie Costley

Title

Licensing and Credentialing Special

Phone

(410) 807-8471

Specialties & licenses 1

Addresses

Tax ID family

Atlanta Detox Center LLC2 organizations share this tax ID, including this one

Part of

Atlanta Detox Center LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Atlanta Detox Center, LLC

  • Substance Abuse Rehabilitation Facility
  • Riverdale, GA
  • NPI 1033694864
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Atlanta Detox Center, LLC

  • Substance Abuse Rehabilitation Facility
  • Riverdale, GA
  • NPI 1033694864
  NPPES parent name

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

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1679155337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 MEDICAL WAY",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742522",
            "telephone_number": "470-298-7236",
            "fax_number": "470-300-8480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 MEDICAL WAY",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302742522",
            "telephone_number": "470-298-7236",
            "fax_number": "470-300-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA DETOX CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ATLANTA DETOX CENTER, LLC",
        "enumeration_date": "2021-04-22",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "COSTLEY",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "LICENSING AND CREDENTIALING SPECIAL",
        "authorized_official_telephone_number": "410-807-8471"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.