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General NPI Number Information
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NPI Number | 1215103767
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Entity Type | Organization
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Legal Business Name | ATLANTA CENTER FOR FAMILY WELLNESS, LLC
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Dates
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Enumeration Date | 05/05/2008
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Last Update Date | 03/27/2013
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Provider Practice Location Address
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Address Line | 1401 PEACHTREE ST NE STE 210
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City | ATLANTA
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State | GA
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Zip | 30309-3000
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Country | US
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Telephone | 404-550-9981
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Fax | 404-475-4880
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Provider Business Mailing Address
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Address Line | PO BOX 7730
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City | ATLANTA
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State | GA
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Zip | 30357-0730
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Country | US
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Telephone | 404-550-9981
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. NATHANIEL ANDREW WILSON III
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Credential | PSY.D.
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Telephone | 404-550-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY002857
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License Number State | GA
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