| NPI | 1194226068 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATRICE LEE Biller 404-947-1081 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: MD 20171710) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MD 20130228) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2018-02-26 |