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General NPI Number Information
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NPI Number | 1417742867
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Entity Type | Organization
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Legal Business Name | AYMETHIST LLC
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 990 PEACHTREE INDUSTRIAL BLVD UNIT 688
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City | SUWANEE
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State | GA
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Zip | 30024-5208
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Country | US
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Telephone | 904-209-7126
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Fax |
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Provider Business Mailing Address
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Address Line | 990 PEACHTREE INDUSTRIAL BLVD UNIT 688
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City | SUWANEE
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State | GA
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Zip | 30024-5208
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Country | US
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Telephone | 404-585-7110
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | YAMARA NICHOLS
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Credential |
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Telephone | 904-209-7126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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