| NPI | 1508470212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY CLEVELAND Owner 404-664-2505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2100X Nurse Practitioner, Acute Care | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2020-09-01 |