| NPI | 1154889665 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY C HENDERSON Pharmacist 404-271-8768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center Methadone |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2024-10-30 |