| Sullivan Psychiatric Svcs Llc | |
|
425 Allgood Rd Stone Mountain GA 30083-6145 | |
| (404) 508-3822 | |
| (404) 508-3823 |
| Full Name | Sullivan Psychiatric Svcs Llc |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 425 Allgood Rd, Stone Mountain, Georgia |
| Authorized Official Name and Position | Raina Sullivan (OWNER) |
| Authorized Official Contact | 4045083822 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sullivan Psychiatric Svcs Llc 425 Allgood Rd Stone Mountain GA 30083-6145 Ph: (404) 508-3822 | Sullivan Psychiatric Svcs Llc 425 Allgood Rd Stone Mountain GA 30083-6145 Ph: (404) 508-3822 |
| NPI Number | 1164756839 |
|---|---|
| Provider Enumeration Date | 09/28/2009 |
| Last Update Date | 09/28/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164756839 | NPI | - | NPPES |
| 343324511A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 047162 (Georgia) | Primary |
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