| Providence Neuropsychiatric Health, Llc | |
|
709 Breedlove Dr Monroe GA 30655-2055 | |
| (717) 460-8885 | |
| Not Available |
| Full Name | Providence Neuropsychiatric Health, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 709 Breedlove Dr, Monroe, Georgia |
| Authorized Official Name and Position | Adewumi Adebomojo (OWNER) |
| Authorized Official Contact | 7174608885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Neuropsychiatric Health, Llc 2483 Heritage Village Suite 16 - 490 Snellville GA 30078 Ph: (470) 610-0644 | Providence Neuropsychiatric Health, Llc 709 Breedlove Dr Monroe GA 30655-2055 Ph: (717) 460-8885 |
| NPI Number | 1710483409 |
|---|---|
| Provider Enumeration Date | 04/02/2018 |
| Last Update Date | 10/30/2022 |
| Certification Date | 10/30/2022 |
| Medicare PECOS PAC ID | 8426302803 |
|---|---|
| Medicare Enrollment ID | O20181121002636 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710483409 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Adewumi T Adebomojo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558591248 PECOS PAC ID: 5991948374 Enrollment ID: I20170522001184 |
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