| Business Owner | |
|
6572 River Park Dr Ste 101g Riverdale GA 30274-2214 | |
| (404) 734-4445 | |
| (404) 745-0552 |
| Full Name | Business Owner |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 6572 River Park Dr Ste 101g, Riverdale, Georgia |
| Authorized Official Name and Position | Ralph Ogwotu (BUSINESS OWNER) |
| Authorized Official Contact | 4047344445 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Business Owner 110 W Pier Way Fayetteville GA 30214-4617 Ph: (404) 734-4666 | Business Owner 6572 River Park Dr Ste 101g Riverdale GA 30274-2214 Ph: (404) 734-4445 |
| NPI Number | 1902670490 |
|---|---|
| Provider Enumeration Date | 11/14/2023 |
| Last Update Date | 07/10/2024 |
| Certification Date | 07/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902670490 | NPI | - | NPPES |
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