| NPI | 1841067758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LEDBETTER Credentialing Specialist 678-964-0510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2024-02-16 |