| 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 |