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Organization
JEHOVAHS BEHAVIORAL CARE LLC
Active
Organization
JEHOVAHS BEHAVIORAL CARE LLC
Active
Other names
GRACE FOMUNUNG SOLE MBR
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRACE FOMUNUNG PMHNP (MANAGER)
(404) 819-7338
Entity
Organization
Contact information
Practice address
3206 THIMBLEBERRY TRL, DACULA, GA 30019-7299
(404) 819-7338
Mailing address
4652 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-3621
(404) 819-7338
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
NULL
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/02/2022
Last updated
11/15/2022
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