Provider Demographics
NPI:1689938326
Name:STRONGTOWER BEHAVIORAL HEALTHCARE LLC
Entity Type:Organization
Organization Name:STRONGTOWER BEHAVIORAL HEALTHCARE LLC
Other - Org Name:KOOLNIGHT INSOMNIA AND SLEEP SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:OPEOLUWA
Authorized Official - Middle Name:OLABISI
Authorized Official - Last Name:AKINNUSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-218-9586
Mailing Address - Street 1:3750 PALLADIAN VILLAGE DR
Mailing Address - Street 2:SUITE 110 & 120
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-8200
Mailing Address - Country:US
Mailing Address - Phone:678-265-8361
Mailing Address - Fax:678-265-8362
Practice Address - Street 1:3750 PALLADIAN VILLAGE DR
Practice Address - Street 2:SUITE 110 & 120
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-8200
Practice Address - Country:US
Practice Address - Phone:678-265-8361
Practice Address - Fax:678-265-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064741207RS0012X
GA648022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA64802OtherMEDICAL LICENCE NUMBER
GA64802OtherMEDICAL LICENCE NUMBER