| Done | |
|
1201 W Peachtree St Nw Ste 2300 Atlanta GA 30309-3453 | |
| (415) 735-5804 | |
| Not Available |
| Full Name | Done |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1201 W Peachtree St Nw Ste 2300, Atlanta, Georgia |
| Authorized Official Name and Position | Credentialing Department (OFFICE MANAGER/BUSINESS STAFF CONTA) |
| Authorized Official Contact | 4156712165 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Done 1201 W Peachtree St Nw Ste 2300 Atlanta GA 30309-3453 Ph: (415) 735-5804 | Done 1201 W Peachtree St Nw Ste 2300 Atlanta GA 30309-3453 Ph: (415) 735-5804 |
| NPI Number | 1508648403 |
|---|---|
| Provider Enumeration Date | 10/17/2023 |
| Last Update Date | 11/08/2023 |
| Certification Date | 10/30/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508648403 | NPI | - | NPPES |
| 94465 | Other | GA | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
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