| NPI | 1467131086 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE RENEE TAMBASCO Provider 770-309-5891 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2023-07-12 |