Individual provider · Type 1 NPI
Jamita Martin
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Acworth, GA
Practice location
6468 Hwy 92, Suite 140
Acworth, GA 30102-0005
Fax (855) 413-6890
Mailing address
PO Box 2298
Acworth, GA 30102-0005
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | LC20150000857 (GA) |
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
About NPI 1366807778
Jamita Martin's National Provider Identifier is 1366807778, issued on Dec 30, 2015. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Acworth, GA. The record was last updated on Dec 30, 2015.