| NPI | 1376304402 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASSANDRA SHEA GILLIAM Owner 478-496-4896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-01-16 |
| Last Update Date | 2024-12-12 |