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General NPI Number Information
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NPI Number | 1780296533
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Entity Type | Organization
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Legal Business Name | NORTH ATLANTA MENTAL WELLNESS
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 1742 MOUNT VERNON RD STE 150B
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City | ATLANTA
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State | GA
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Zip | 30338-4251
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Country | US
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Telephone | 631-512-1567
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Fax |
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Provider Business Mailing Address
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Address Line | 1742 MOUNT VERNON RD STE 150B
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City | ATLANTA
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State | GA
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Zip | 30338-4251
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RYAN CIERZNIEWSKI
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Credential |
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Telephone | 631-512-1567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 261Q00000X
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Taxonomy Name | 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 | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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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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