| NPI | 1245828805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMNI WEBSTER Office Manager 470-695-4515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2021-01-08 |