| NPI | 1790393684 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA MARIE GRAY Owner 678-568-9377 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2020-07-17 |