Healthcare Provider Details

I. General information

NPI: 1528973245
Provider Name (Legal Business Name): CSRP INTEGRATIVE PSYCHIATRY LIMITED LIABILITY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 ATLANTA HWY
HIRAM GA
30141-1854
US

IV. Provider business mailing address

72 VALLEY VIEW TRL
DALLAS GA
30132-5465
US

V. Phone/Fax

Practice location:
  • Phone: 470-997-2705
  • Fax:
Mailing address:
  • Phone: 470-997-2705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FAITH ENWEFAH
Title or Position: OWNER
Credential:
Phone: 470-997-2705