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44 Darbys Crossing Dr Ste 202 Hiram GA 30141-6008 | |
| (404) 850-2020 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 44 Darbys Crossing Dr Ste 202, Hiram, Georgia |
| Authorized Official Name and Position | James Sample Elliott (OWNER) |
| Authorized Official Contact | 4048502020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
44 Darbys Crossing Dr Ste 202 Hiram GA 30141-6008 Ph: (404) 850-2020 | 44 Darbys Crossing Dr Ste 202 Hiram GA 30141-6008 Ph: (404) 850-2020 |
| NPI Number | 1851924930 |
|---|---|
| Provider Enumeration Date | 02/18/2020 |
| Last Update Date | 04/14/2021 |
| Certification Date | 04/14/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851924930 | NPI | - | NPPES |
| LPC010314 | Other | GA | GA BOARD OF PROF. COUNSELORS, SOCIAL WORKERS, AND MARRIAGE & FAMILY THERAPISTS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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