| NPI | 1396277968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHASITY WEINER Regional Director Of Managed Care 470-805-2693 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 55563) |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: GA 58297) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 59016) | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 060325) | |
| Enumeration Date | 2017-04-01 |
| Last Update Date | 2024-02-16 |