| Ivy Collaborative Healthcare | |
|
2100 Central Avenue Stes 6 & 7 Augusta GA 30904-6717 | |
| (706) 364-3461 | |
| (706) 364-3481 |
| Full Name | Ivy Collaborative Healthcare |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2100 Central Avenue, Augusta, Georgia |
| Authorized Official Name and Position | Jocelyn Kelly Bayliss (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7063643461 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Collaborative Healthcare 2100 Central Avenue Stes 6 & 7 Augusta GA 30904-6709 Ph: (706) 364-3461 | Ivy Collaborative Healthcare 2100 Central Avenue Stes 6 & 7 Augusta GA 30904-6717 Ph: (706) 364-3461 |
| NPI Number | 1043845373 |
|---|---|
| Provider Enumeration Date | 03/06/2020 |
| Last Update Date | 05/07/2024 |
| Certification Date | 05/07/2024 |
| Medicare PECOS PAC ID | 4183065907 |
|---|---|
| Medicare Enrollment ID | O20240510002425 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043845373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Jocelyn K Bayliss |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679860522 PECOS PAC ID: 1052551652 Enrollment ID: I20160808002689 |
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