| Lighthorse Psychiatry Llc | |
|
102 Lakeshore Dr Ste B Saint Marys GA 31558-3875 | |
| (912) 882-3800 | |
| (912) 882-3303 |
| Full Name | Lighthorse Psychiatry Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 102 Lakeshore Dr Ste B, Saint Marys, Georgia |
| Authorized Official Name and Position | Nina C Leonard (APRN) |
| Authorized Official Contact | 9126739907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthorse Psychiatry Llc 102 Lakeshore Dr Ste B Saint Marys GA 31558-3875 Ph: (912) 882-3800 | Lighthorse Psychiatry Llc 102 Lakeshore Dr Ste B Saint Marys GA 31558-3875 Ph: (912) 882-3800 |
| NPI Number | 1699208777 |
|---|---|
| Provider Enumeration Date | 04/06/2017 |
| Last Update Date | 12/02/2020 |
| Certification Date | 12/02/2020 |
| Medicare PECOS PAC ID | 8628323953 |
|---|---|
| Medicare Enrollment ID | O20180609000000 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699208777 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | RN044413 (Georgia) | Primary |
| Provider Name | Nina Leonard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679877526 PECOS PAC ID: 8921259698 Enrollment ID: I20121107000197 |
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