| Genesis Alliance For Mental Wellness, Llc | |
|
4759 Rockbridge Rd Ste E Stone Mountain GA 30083-4295 | |
| (404) 501-0003 | |
| (404) 501-0033 |
| Full Name | Genesis Alliance For Mental Wellness, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4759 Rockbridge Rd, Stone Mountain, Georgia |
| Authorized Official Name and Position | Temeka Abbott (CEO) |
| Authorized Official Contact | 4045010003 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Alliance For Mental Wellness, Llc 4759 Rockbridge Rd Ste E Stone Mountain GA 30083-4295 Ph: (404) 501-0003 | Genesis Alliance For Mental Wellness, Llc 4759 Rockbridge Rd Ste E Stone Mountain GA 30083-4295 Ph: (404) 501-0003 |
| NPI Number | 1891816906 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 12/08/2011 |
| Medicare PECOS PAC ID | 8921383944 |
|---|---|
| Medicare Enrollment ID | O20200309001516 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891816906 | NPI | - | NPPES |
| 042312259A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Adaku Nwakego Njoku - Animashaun |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164682431 PECOS PAC ID: 7416253919 Enrollment ID: I20181101003026 |
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