| NPI | 1396277968 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KALEY DAVIS Provider Enrollment Associate 470-857-4412 |
| 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 | 2025-03-31 |