| NPI | 1851151427 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZZETTE VAN-LARE Owner 678-907-3060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-03-20 |
| Last Update Date | 2024-03-20 |