Organization
DELIVERANCE HEALTH LIMITED LIABILITY COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBOTE N NNOKO (OWNER)
(404) 934-6010
Entity
Organization
Contact information
Practice address
108 CRESCENT WOODE DR, DALLAS, GA 30157-5725
(404) 934-6010
Mailing address
108 CRESCENT WOODE DR, DALLAS, GA 30157-5725
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/11/2021
Last updated
10/14/2021
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