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6736 Bill Carruth Pkwy Apt 901 Hiram GA 30141-3794 | |
| (678) 829-2466 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 6736 Bill Carruth Pkwy Apt 901, Hiram, Georgia |
| Authorized Official Name and Position | Anthony Ray Moon (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 4042008907 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3446 Parsons Greene Ct Powder Springs GA 30127-4428 Ph: (404) 200-8907 | 6736 Bill Carruth Pkwy Apt 901 Hiram GA 30141-3794 Ph: (678) 829-2466 |
| NPI Number | 1891557492 |
|---|---|
| Provider Enumeration Date | 01/29/2024 |
| Last Update Date | 01/29/2024 |
| Certification Date | 01/29/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891557492 | NPI | - | NPPES |
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