| NPI | 1104657436 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD POTTS CEO 770-851-7662 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2024-08-08 |
| Last Update Date | 2024-08-08 |