| Clarvida | |
|
1727 Wrightsboro Rd Ste B Augusta GA 30904-4049 | |
| (912) 638-0350 | |
| (706) 736-8184 |
| Full Name | Clarvida |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1727 Wrightsboro Rd Ste B, Augusta, Georgia |
| Authorized Official Name and Position | Patrick Waters (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7062008677 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clarvida 1727 Wrightsboro Rd Ste B Augusta GA 30904-4049 Ph: (912) 638-0350 | Clarvida 1727 Wrightsboro Rd Ste B Augusta GA 30904-4049 Ph: (912) 638-0350 |
| NPI Number | 1356490304 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 07/10/2024 |
| Certification Date | 07/10/2024 |
| Medicare PECOS PAC ID | 8224330410 |
|---|---|
| Medicare Enrollment ID | O20160105001725 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356490304 | NPI | - | NPPES |
| 000902063AQ | Medicaid | GA | |
| 000902063U | Medicaid | GA | |
| 000902063AR | Medicaid | GA | |
| 000902063L | Medicaid | GA | |
| 000902063AY | Medicaid | GA | |
| 000902063F | Medicaid | GA | |
| 000902063V | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | K935294 (Delaware) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Vickie Bryant Harris |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1134185192 PECOS PAC ID: 5395637854 Enrollment ID: I20040329000605 |
| Provider Name | Ajai Kalla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1245327998 PECOS PAC ID: 7911979091 Enrollment ID: I20040810000057 |
| Provider Name | Mary Tyson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780669218 PECOS PAC ID: 8325010416 Enrollment ID: I20040810000188 |
| Provider Name | Prakash Merai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851488498 PECOS PAC ID: 0648242784 Enrollment ID: I20040810000620 |
| Provider Name | Sarita Sharma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225013568 PECOS PAC ID: 9830136167 Enrollment ID: I20050408000414 |
| Provider Name | Lydia Lee Daley |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1245385855 PECOS PAC ID: 9638351604 Enrollment ID: I20110311000546 |
| Provider Name | Karen B Stevenson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609968825 PECOS PAC ID: 0345256632 Enrollment ID: I20151202001102 |
| Provider Name | Edward G Pellicano |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225094402 PECOS PAC ID: 4981771490 Enrollment ID: I20160201001034 |
| Provider Name | Benjamin Franklin Roy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013021492 PECOS PAC ID: 5294911103 Enrollment ID: I20160303000294 |
| Provider Name | Mary Ann Daniel |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518041219 PECOS PAC ID: 1153544267 Enrollment ID: I20170109001126 |
| Provider Name | Tara N Parent |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356657761 PECOS PAC ID: 9638453749 Enrollment ID: I20170308001550 |
| Provider Name | Gloria L Downey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669456380 PECOS PAC ID: 4688615750 Enrollment ID: I20180726001858 |
| Provider Name | Brandy Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730747593 PECOS PAC ID: 2668704834 Enrollment ID: I20191022000865 |
| Provider Name | Alexandra L Dodd |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902330277 PECOS PAC ID: 7012280506 Enrollment ID: I20210727002598 |
| Provider Name | Rajendra Paladugu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285748640 PECOS PAC ID: 1153327150 Enrollment ID: I20220527000392 |
| Provider Name | Adina C Crawford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1538880034 PECOS PAC ID: 5092182386 Enrollment ID: I20221028001569 |
| Provider Name | Linda F Stafford |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437811460 PECOS PAC ID: 1153775655 Enrollment ID: I20231003001282 |
| Provider Name | Jacquelina Pickett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1639635873 PECOS PAC ID: 2567808801 Enrollment ID: I20240309000108 |
| Provider Name | Nicole Meagher |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1619343456 PECOS PAC ID: 3476990128 Enrollment ID: I20240318002322 |
| Provider Name | Kiera Shervington |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962795625 PECOS PAC ID: 5991143711 Enrollment ID: I20240329000426 |
| Provider Name | Brian M Germann |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396862744 PECOS PAC ID: 1355780180 Enrollment ID: I20240412002834 |
| Provider Name | Olha Maxwell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1528439551 PECOS PAC ID: 9537508965 Enrollment ID: I20240418002464 |
| Provider Name | Ronda Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114383551 PECOS PAC ID: 6305286212 Enrollment ID: I20240425002071 |
Serenity Behavioral Health Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3421 Mike Padgett Hwy, Augusta, GA 30906 Phone: 706-432-7893 | |
Able Tree Atc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3736 Executive Center Dr, Augusta, GA 30907 Phone: 706-426-4200 | |
Breakthrough Counseling, Coaching And Consulting Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2903 Galahad Way, Augusta, GA 30909 Phone: 404-496-4614 Fax: 866-923-0754 | |
Samantha L Amses Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 211 Pleasant Home Rd Ste G1, Augusta, GA 30907 Phone: 908-433-4484 Fax: 706-364-4589 | |
Perez Counseling And Consulting Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1051 Sims Dr, Augusta, GA 30909 Phone: 706-589-0914 | |
Living-in-care Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 716 5th St, Augusta, GA 30901 Phone: 912-605-6167 | |
Clarvida Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1341 Druid Park Ave, Augusta, GA 30904 Phone: 706-364-9037 Fax: 706-364-9096 |