Divine Access LLC
Nurse Practitioner, Psych/Mental Health in Suwanee, GA. Organization (NPI-2).
NPI number1902646292
StatusActive
Last updated in NPPESJun 2, 2024
Details
- NPI
- 1902646292
- Entity type
- Organization (NPI-2)
- Legal business name
- Divine Access LLC
- Organization subpart
- No
- Enumeration date
- May 25, 2024
- Certification date
- Jun 2, 2024
- Last updated
- Jun 2, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
Practice location
167 Gilliflower ParkSuwanee, GA 30024-6456
Phone 770-983-4084
Mailing address
990 Peachtree Industrial BlvdP.O.Box 938
Suwanee, GA 30024-9998
Phone 770-983-4048
Authorized official
Udu Oladeinde
Manager
7709834048
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