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General NPI Number Information
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NPI Number | 1194226068
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Entity Type | Organization
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Legal Business Name | AXIS HOPE, LLC
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Dates
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Enumeration Date | 02/26/2018
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Last Update Date | 02/26/2018
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Provider Practice Location Address
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Address Line | 2551 ROSWELL RD STE 420
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City | MARIETTA
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State | GA
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Zip | 30062-4761
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Country | US
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Telephone | 678-648-7888
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Fax |
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Provider Business Mailing Address
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Address Line | 2551 ROSWELL RD STE 420
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City | MARIETTA
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State | GA
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Zip | 30062-4761
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLER
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Name | LATRICE LEE
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Credential |
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Telephone | 404-947-1081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 20130228
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 20171710
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License Number State | MD
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