Organization
REINVENT YOUR IDENTITY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABIDEMI MARSH (OWNER)
(404) 644-4198
Entity
Organization
Contact information
Practice address
4403 KADY CT, MCDONOUGH, GA 30252-3700
(404) 644-4198
Mailing address
4403 KADY CT, MCDONOUGH, GA 30252-3700
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
261QC1800X
Corporate Health Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QS1000X
Student Health Clinic/Center
—
—
Other
Enumeration date
04/11/2022
Last updated
04/11/2022
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