| NPI | 1407397037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN HUTHWAITE President 678-462-0762 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: GA PSY002863) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: GA PSY002863) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2017-03-15 |