1659313195 NPI number — ATLANTA PSYCHIATRIC INSTITUTE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659313195 NPI number — ATLANTA PSYCHIATRIC INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA PSYCHIATRIC INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659313195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27270
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31221-7270
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-405-5880
Provider Business Mailing Address Fax Number:
478-405-5992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 LAUREL SPRINGS PKWY
Provider Second Line Business Practice Location Address:
UNIT 602
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-6056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-573-9255
Provider Business Practice Location Address Fax Number:
770-573-0505
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHILAKAMARRI
Authorized Official First Name:
JAGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-573-9255

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GRP2056 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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