Individual
JUSTIN VASSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1903 PHOENIX BOULEVARD, SUITE 200, COLLEGE PARK, GA 30349
(678) 335-9010
(678) 229-9906
Mailing address
1903 PHOENIX BLVD STE 200, COLLEGE PARK, GA 30349-5700
(678) 335-9010
(678) 229-9906
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN169074
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881848174
PSYCHIATRY
GA
Enumeration date
08/27/2019
Last updated
08/27/2019
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