Provider Demographics
NPI:1407627805
Name:ALICE'S PSYCHIATRY & WELLNESS, LLC
Entity Type:Organization
Organization Name:ALICE'S PSYCHIATRY & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:OMOYEME
Authorized Official - Middle Name:
Authorized Official - Last Name:EHIZUELEN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:404-566-8045
Mailing Address - Street 1:1700 NORTHSIDE DRIVE NW SUITE A7
Mailing Address - Street 2:PMB 2078
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318
Mailing Address - Country:US
Mailing Address - Phone:404-566-8045
Mailing Address - Fax:
Practice Address - Street 1:1700 NORTHSIDE DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2673
Practice Address - Country:US
Practice Address - Phone:404-566-8045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty