| NPI | 1205246899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAHEEDAH BOLES Owner 912-921-8789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN151817) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2016-01-02 |