Provider Demographics
NPI:1710483409
Name:PROVIDENCE NEUROPSYCHIATRIC HEALTH, LLC
Entity Type:Organization
Organization Name:PROVIDENCE NEUROPSYCHIATRIC HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEWUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBOMOJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-460-8885
Mailing Address - Street 1:2483 HERITAGE VILLAGE
Mailing Address - Street 2:SUITE 16 - 490
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:470-610-0644
Mailing Address - Fax:470-610-0650
Practice Address - Street 1:709 BREEDLOVE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2055
Practice Address - Country:US
Practice Address - Phone:717-460-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty