OrganizationActive
Creative Life Center, LLC
NPI 1780227140 · Geriatric Psychiatry Physician · Grayson, GA
Provider details
- NPI number
- 1780227140
- Entity type
- Organization
- Primary specialty
- Geriatric Psychiatry PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Muhammad Ahmed, Ceo(678) 344-8268
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Psychiatry Physician2084P0800X
Allopathic & Osteopathic Physicians
- Mental Health Counselor101YM0800X
Behavioral Health & Social Service Providers
- Day Training/Habilitation Specialist373H00000X
Nursing Service Related Providers
Practice location
1637 Athens Hwy Ste B
Grayson, GA 30017-1768
Phone: (678) 344-8269
Fax: (888) 627-6444
Approximate (ZIP-level) locationGet directions
Mailing address
1637 Athens Hwy
Grayson, GA 30017-1768
Registry dates
- Enumerated
- 2019-10-17
- Last updated
- 2021-05-18
- Certified
- 2021-05-18
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.