Organization
GEORGIA KETAMINE RENEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI NICHOLSON MD (OWNER)
(404) 406-4191
Entity
Organization
Contact information
Practice address
1370 THOMPSON BRIDGE RD STE 101, GAINESVILLE, GA 30501-1780
(678) 769-7008
Mailing address
1370 THOMPSON BRIDGE RD STE 101, GAINESVILLE, GA 30501-1780
(678) 769-7008
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
—
—
261QM2500X
Medical Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34210
LICENSE
GA
Enumeration date
04/21/2020
Last updated
04/21/2020
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us