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General NPI Number Information
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NPI Number | 1104527944
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Entity Type | Organization
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Legal Business Name | OUR HOUSE, INC.
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 173 BOULEVARD NE
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City | ATLANTA
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State | GA
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Zip | 30312-1468
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Country | US
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Telephone | 404-658-1500
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Fax | 404-522-6170
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Provider Business Mailing Address
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Address Line | 173 BOULEVARD NE
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City | ATLANTA
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State | GA
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Zip | 30312-1468
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Country | US
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Telephone |
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Fax | 404-522-6170
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Authorized Official
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Title or Position | CEO & PRESIDENT
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Name | TYESE LAWYER
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Credential |
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Telephone | 404-522-6056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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