| NPI | 1033856307 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY WIDEMAN CEO/Owner 678-235-4853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2022-11-22 |