# THE LOTUS HAVEN PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Lotus Haven PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164035564
- **Authorized official:** TYRONJALA GAINEY- GRANT NP (CEO)
- **Authorized official phone:** (404) 944-1174

## Contact information

- **Practice address:** 950 DANNON VW SW STE 4101, ATLANTA, GA 30331-2159
- **Practice address phone:** (404) 944-1174
- **Mailing address:** 425 DUTCHVIEW DR, ATLANTA, GA 30349-7642

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/25/2020
- **Last updated:** 12/09/2024