| NPI | 1164035564 |
|---|---|
| Doing Business As | THE LOTUS HAVEN PC |
| Entity Type | Organization |
| Authorized Contact | TYRONJALA GAINEY- GRANT CEO 404-944-1174 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| 261QU0200X Clinic/Center, Urgent Care | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2024-12-09 |