Healthcare Provider Details

I. General information

NPI: 1003752247
Provider Name (Legal Business Name): GWINNETT HOLISTIC PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 KILLIAN HILL RD SW STE 202N
LILBURN GA
30047-3110
US

IV. Provider business mailing address

4335 BENDING RIVER TRL SW
LILBURN GA
30047-4554
US

V. Phone/Fax

Practice location:
  • Phone: 678-400-4424
  • 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: THOMAS YUN
Title or Position: OWNER
Credential: MD
Phone: 678-400-4424