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General NPI Number Information
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NPI Number | 1457959017
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Entity Type | Organization
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Legal Business Name | PERISCOPE COMMUNITY HEALTH SERVICES
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 167 BELLE FOREST CIR
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City | NASHVILLE
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State | TN
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Zip | 37221-2103
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Country | US
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Telephone | 404-641-4594
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Fax |
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Provider Business Mailing Address
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Address Line | 2436 HADLOW LN SE
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City | ATLANTA
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State | GA
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Zip | 30339-9020
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Country | US
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Telephone | 404-461-4594
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Fax |
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Authorized Official
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Title or Position | ECO
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Name | MR. ARZINE IHEME
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Credential |
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Telephone | 404-461-4594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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