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General NPI Number Information
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NPI Number | 1407627805
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Entity Type | Organization
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Legal Business Name | ALICE'S PSYCHIATRY & WELLNESS, LLC
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 08/07/2024
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Provider Practice Location Address
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Address Line | 680 HILLCREST RD NW STE 400
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City | LILBURN
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State | GA
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Zip | 30047-6898
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Country | US
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Telephone | 404-566-8045
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Fax | 404-999-6787
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Provider Business Mailing Address
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Address Line | 1700 NORTHSIDE DRIVE NW SUITE A7 PMB 2078
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City | ATLANTA
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State | GA
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Zip | 30318
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Country | US
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Telephone | 404-566-8045
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | OMOYEME EHIZUELEN
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Credential | PMHNP-BC
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Telephone | 404-566-8045
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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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