| Promedica Psychiatry Group | |
|
2430 Tucker Dr Bldg A Loganville GA 30052-4390 | |
| (770) 554-8812 | |
| (770) 554-9810 |
| Full Name | Promedica Psychiatry Group |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 2430 Tucker Dr, Loganville, Georgia |
| Authorized Official Name and Position | Kimberly H. Littrell (PRESIDENT & CEO) |
| Authorized Official Contact | 7705548812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Promedica Psychiatry Group 2430 Tucker Dr Bldg A Loganville GA 30052-4390 Ph: (770) 554-8812 | Promedica Psychiatry Group 2430 Tucker Dr Bldg A Loganville GA 30052-4390 Ph: (770) 554-8812 |
| NPI Number | 1922036508 |
|---|---|
| Provider Enumeration Date | 06/30/2006 |
| Last Update Date | 04/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922036508 | NPI | - | NPPES |
| 00345408A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 029689 (Georgia) | Primary |
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