Provider Demographics
NPI:1417742867
Name:AYMETHIST LLC
Entity type:Organization
Organization Name:AYMETHIST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-209-7126
Mailing Address - Street 1:990 PEACHTREE INDUSTRIAL BLVD UNIT 688
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5208
Mailing Address - Country:US
Mailing Address - Phone:404-585-7110
Mailing Address - Fax:
Practice Address - Street 1:990 PEACHTREE INDUSTRIAL BLVD UNIT 688
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5208
Practice Address - Country:US
Practice Address - Phone:904-209-7126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-14
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health