NPI | 1811610223 |
---|---|
Entity Type | Organization |
Authorized Contact | SHUCONDA STURDIVANT Administrator 678-863-5537 |
Organization Subpart ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
Enumeration Date | 2022-09-21 |
Last Update Date | 2025-07-31 |