MEDICARE: BLOSSOM TOUCH INTEGRATED PSYCHIATRY LTD CO.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1750909339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOSSOM TOUCH INTEGRATED PSYCHIATRY LTD CO.

Provider Business Mailing Address
First Line	:	11815 NORTHFALL LN
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-7973
Country	:	US
Telephone Number	:	425-659-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	11815 NORTHFALL LN
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-7973
Country	:	US
Telephone Number	:	425-659-5073
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLAWUNMI OGUN-SEMORE
Credential	:	DNP
Telephone Number	:	425-659-5073

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	03/05/2026

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