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General NPI Number Information
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NPI Number | 1154138089
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Entity Type | Organization
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Legal Business Name | ON TRACK PSYCHIATRY LLC
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1870 THE EXCHANGE SE STE 200 #1299
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City | ATLANTA
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State | GA
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Zip | 30339
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Country | US
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Telephone | 678-643-2072
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Fax |
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Provider Business Mailing Address
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Address Line | 3119 FONSECA PASS
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City | ATLANTA
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State | GA
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Zip | 30349-8140
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Country | US
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Telephone | 678-643-2072
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TONDALAYA SANFORD
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Credential |
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Telephone | 513-200-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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