| NPI | 1205375862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY CRISOSTOMO CEO 678-908-0006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service (Licence: GA RN141244) |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2023-10-24 |