Organization
UN SIMPLE MINDED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMIR BERNARD LANE (OWNER)
(678) 975-5539
Entity
Organization
Contact information
Practice address
810 EAGLE COVE WAY, LAWRENCEVILLE, GA 30044-5843
(678) 975-5539
Mailing address
810 EAGLE COVE WAY, LAWRENCEVILLE, GA 30044-5843
(678) 975-5539
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
01/11/2022
Last updated
01/11/2022
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