| NPI | 1467243899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE BONE Billing/Credentialing Admin 706-409-3072 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-05-15 |
| Last Update Date | 2025-08-25 |