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NPI 1164240891

NPI 1164240891 : BAHR HOLISTIC PSYCHIATRY : TYRONE, GA

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General NPI Number Information
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    NPI Number           |    1164240891
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    Entity Type          |    Organization 
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    Legal Business Name  |    BAHR HOLISTIC PSYCHIATRY 
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Dates
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    Enumeration Date     |    10/01/2024
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    Last Update Date     |    10/01/2024
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Provider Practice Location Address
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    Address Line         |    210 NEWFIELD DR 
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    City                 |    TYRONE
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    State                |    GA
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    Zip                  |    30290-2576
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    Country              |    US
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    Telephone            |    646-981-3117
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    PO BOX 551 
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    City                 |    FAYETTEVILLE
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    State                |    GA
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    Zip                  |    30214-0551
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    Country              |    US
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    Telephone            |    646-981-3117
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    Fax                  |    
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Authorized Official
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    Title or Position    |    FNP AND PMHNP
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    Name                 |     RUGIATU  BAHR 
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    Credential           |    NP
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    Telephone            |    646-981-3117
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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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