Healthcare Provider Details

I. General information

NPI: 1902734452
Provider Name (Legal Business Name): CORE HORIZONS TELEPSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 PACES FERRY RD SE STE 500
ATLANTA GA
30339-5714
US

IV. Provider business mailing address

2721 BENCH CIR
ELLENWOOD GA
30294-5510
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax: --
Mailing address:
  • Phone: --
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JONITA GREEN
Title or Position: OWNER
Credential:
Phone: --