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The Lotus Haven PC

Nurse Practitioner, Psych/Mental Health in Atlanta, GA. Organization (NPI-2).

NPI number1164035564
StatusActive
Last updated in NPPESDec 9, 2024

Details

NPI
1164035564
Entity type
Organization (NPI-2)
Legal business name
The Lotus Haven PC
Organization subpart
No
Enumeration date
Aug 25, 2020
Certification date
Dec 9, 2024
Last updated
Dec 9, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0808X Nurse Practitioner, Psych/Mental Health––Yes
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––
261QU0200X Clinic/Center, Urgent Care––
363LF0000X Nurse Practitioner, Family––

Other names

  • The Lotus Haven PC (Doing Business As)

Practice location

950 Dannon Vw Sw Ste 4101
Atlanta, GA 30331-2159

Phone 404-944-1174

Mailing address

425 Dutchview Dr
Atlanta, GA 30349-7642

Authorized official

Tyronjala Gainey- Grant
Ceo
4049441174

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

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