| NPI | 1619612876 |
|---|---|
| Doing Business As | GRACE FOMUNUNG SOLE MBR |
| Entity Type | Organization |
| Authorized Contact | GRACE FOMUNUNG Manager 404-819-7338 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-05-02 |
| Last Update Date | 2022-11-15 |