Healthcare Provider Details

I. General information

NPI: 1598250342
Provider Name (Legal Business Name): AVANT BEHAVIORAL CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 MULKEY RD STE 202
AUSTELL GA
30106-1150
US

IV. Provider business mailing address

880 MARIETTA HWY STE 630366
ROSWELL GA
30075-6755
US

V. Phone/Fax

Practice location:
  • Phone: 770-694-6349
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: OKAH ANYOKWU
Title or Position: OWNER
Credential: MD
Phone: 573-999-0193