Organization
ASCENSION PSYCHIATRIC SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY HAMES HALL APRN (CEO)
(310) 890-6033
Entity
Organization
Contact information
Practice address
330 PHILLIPS DR, FAYETTEVILLE, GA 30214-4375
(310) 809-6033
Mailing address
330 PHILLIPS DR, FAYETTEVILLE, GA 30214-4375
(310) 809-6033
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558904169
—
GA
Enumeration date
12/25/2021
Last updated
12/25/2021
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