Organization
DEVEREUX GOERGIA TREATMENT NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. YOLANDA PATRICE GRAHAM M.D. (MEDICAL DIRECTOR)
(770) 427-0147
Entity
Organization
Contact information
Practice address
1291 STANLEY RD, KENNESAW, GA 30152
(770) 427-0147
Mailing address
1291 STANLEY RD NW, KENNESAW, GA 30152-4359
(770) 427-0147
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
0038001
GA
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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