| NPI | 1699408005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY BATES Owner 470-275-2358 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2022-07-04 |
| Last Update Date | 2024-02-02 |