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General NPI Number Information
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NPI Number | 1962972851
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Entity Type | Organization
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Legal Business Name | ORI INU, LLC
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 12/04/2018
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Provider Practice Location Address
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Address Line | 1687 HAMILTON AVE
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City | EAST POINT
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State | GA
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Zip | 30344-4249
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Country | US
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Telephone | 470-240-8881
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Fax |
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Provider Business Mailing Address
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Address Line | 1382 CLERMONT AVE
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City | EAST POINT
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State | GA
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Zip | 30344-1754
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Country | US
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Telephone | 404-316-2593
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. KESI MILLER
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Credential | PH.D.
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Telephone | 404-316-2593
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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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