Organization
THE LOTUS HAVEN PC
Active
Other names
The Lotus Haven PC
Organization subpart
No
Provider details
NPI number
Authorized official
TYRONJALA GAINEY- GRANT NP (CEO)
(404) 944-1174
Entity
Organization
Contact information
Practice address
950 DANNON VW SW STE 4101, ATLANTA, GA 30331-2159
(404) 944-1174
Mailing address
425 DUTCHVIEW DR, ATLANTA, GA 30349-7642
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/25/2020
Last updated
12/09/2024
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