| NPI | 1154093383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE BONE Credentialing/Billing Admin 706-409-3072 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2025-01-07 |