Organization
JEHOVAHS BEHAVIORAL CARE LLC
Active
Other names
GRACE FOMUNUNG SOLE MBR
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRACE FOMUNUNG PMHNP (MANAGER)
(404) 819-7338
Entity
Organization
Contact information
Practice address
3206 THIMBLEBERRY TRL, DACULA, GA 30019-7299
(404) 819-7338
Mailing address
4652 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-3621
(404) 819-7338
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
05/02/2022
Last updated
11/15/2022
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