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General NPI Number Information
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NPI Number | 1508639139
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Entity Type | Organization
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Legal Business Name | TRANQUILITY BEHAVIORAL SERVICES LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 2375 WALL ST SE STE 240
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City | CONYERS
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State | GA
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Zip | 30013-2296
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Country | US
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Telephone | 770-679-4567
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Fax | 470-945-4988
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Provider Business Mailing Address
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Address Line | 2375 WALL ST SE STE 240
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City | CONYERS
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State | GA
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Zip | 30013-2296
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Country | US
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Telephone | 770-679-4567
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Fax | 470-945-4988
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONNA MARIE CROSS
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Credential | NP
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Telephone | 770-679-4567
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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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