| Domina Umbrae Llc | |
|
2155 Meador Ave Se Atlanta GA 30315-7407 | |
| (706) 442-9127 | |
| Not Available |
| Full Name | Domina Umbrae Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2155 Meador Ave Se, Atlanta, Georgia |
| Authorized Official Name and Position | William David Miller (OWNER) |
| Authorized Official Contact | 7064429127 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Domina Umbrae Llc 330 High Hardin Way Lawrenceville GA 30043-6091 Ph: (706) 442-9127 | Domina Umbrae Llc 2155 Meador Ave Se Atlanta GA 30315-7407 Ph: (706) 442-9127 |
| NPI Number | 1053748947 |
|---|---|
| Provider Enumeration Date | 10/09/2013 |
| Last Update Date | 10/09/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053748947 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC004441 (Georgia) | Primary |
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