Deliverance Health Limited Liability Company

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

DELIVERANCE HEALTH LIMITED LIABILITY COMPANY

Practice address

108 Crescent Woode Dr
Dallas, GA 30157-5725

Phone

(404) 934-6010

NPI assigned

Oct 11, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ebote N Nnoko

Title

Owner

Phone

(404) 934-6010

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1124780861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 CRESCENT WOODE DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301575725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 CRESCENT WOODE DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301575725",
            "telephone_number": "404-934-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELIVERANCE HEALTH LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-11",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "NNOKO",
        "authorized_official_first_name": "EBOTE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-934-6010"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Dallas, GA
• Providers in Dallas, GA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.