Healthcare Provider Details

I. General information

NPI: 1205342789
Provider Name (Legal Business Name): AMEN CLINICS, INC ATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 PEACHTREE DUNWOODY RD STE C65
ATLANTA GA
30328-7156
US

IV. Provider business mailing address

5901 PEACHTREE DUNWOODY RD STE C65
ATLANTA GA
30328-7156
US

V. Phone/Fax

Practice location:
  • Phone: 678-367-2810
  • Fax: 678-805-8125
Mailing address:
  • Phone: 678-367-2810
  • Fax: 678-805-8125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA T MCCORMICK
Title or Position: CORPORATE TRAINER
Credential:
Phone: 703-880-4000