| NPI | 1871643890 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA PATRICE SHANNON Owner 770-507-0860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084F0202X Psychiatry & Neurology, Forensic Psychiatry (Licence: GA 03661) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: GA 036661) |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: GA 036661) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2020-08-22 |