Organization Name: | GANG BREAKER, INC. |
NPI Number: | 1083034235 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HARRISON TARSHEEN PETERS (FOUNDER/CEO) |
Mailing Address: | 2200 Willow Trail Pkwy Norcross |
State: | GA US |
Postal Code: | 300932525 |
Phone Number: | 4049164538 |
Fax Number: | |
NPI Enumeration Date: | 04/25/2014 |
NPI Last Update Date: | 04/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |