Individual
MEMMA N/A NCHELEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
708 GLEN VALLEY WAY, DACULA, GA 30019-4878
(470) 818-3304
(470) 818-3304
Mailing address
708 GLEN VALLEY WAY # A, DACULA, GA 30019-4878
(470) 818-3304
(470) 818-3304
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN285047
GA
Other
Enumeration date
10/29/2025
Last updated
10/29/2025
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