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General NPI Number Information
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NPI Number | 1730423047
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Entity Type | Organization
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Legal Business Name | NORTH GEORGIA PSYCHIATRIC WELLNESS CENTER LLC
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 2450 ATLANTA HWY SUITE 802
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City | CUMMING
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State | GA
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Zip | 30040-8099
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Country | US
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Telephone | 678-666-6990
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Fax | 770-246-9098
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Provider Business Mailing Address
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Address Line | 3274 LOCKETT TRCE
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City | DULUTH
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State | GA
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Zip | 30097-5013
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Country | US
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Telephone | 678-666-6990
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. KRIS GADDE
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Credential |
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Telephone | 678-666-6990
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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 | 058213979
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License Number State | GA
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