1639442841 NPI number — PSYCARE, LLC

Table of content: (NPI 1639442841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639442841 NPI number — PSYCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PSYCARE, LLC
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:
1639442841
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3270 AMHURST DR NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30318-5949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-630-0716
Provider Business Mailing Address Fax Number:
404-758-3497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
807 N TENNESSEE ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CARTERSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30120-2895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-632-5787
Provider Business Practice Location Address Fax Number:
404-758-3497
Provider Enumeration Date:
02/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRICE
Authorized Official First Name:
GINARI
Authorized Official Middle Name:
RENE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
216-630-0716

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X , with the licence number:  056712 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X , with the licence number: 056712 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 056712 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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