| NPI | 1144273608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN M WAITS Business Manager 770-478-6091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-08-22 |