| Psych Atlanta, P.c. | |
|
1012 Coggins Place Marietta GA 30060-1306 | |
| (770) 422-2009 | |
| (770) 428-0330 |
| Full Name | Psych Atlanta, P.c. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1012 Coggins Place, Marietta, Georgia |
| Authorized Official Name and Position | Micheal David Banov (OWNER) |
| Authorized Official Contact | 7704222009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psych Atlanta, P.c. 1012 Coggins Place Marietta GA 30060-1306 Ph: (770) 422-2009 | Psych Atlanta, P.c. 1012 Coggins Place Marietta GA 30060-1306 Ph: (770) 422-2009 |
| NPI Number | 1184756090 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 08/01/2019 |
| Medicare PECOS PAC ID | 0042293573 |
|---|---|
| Medicare Enrollment ID | O20040608000133 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184756090 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (Georgia) | Primary |
| Provider Name | Raymond J Kotwicki |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770696783 PECOS PAC ID: 8820060205 Enrollment ID: I20040806000718 |
| Provider Name | Stacey Heit |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700965175 PECOS PAC ID: 1052371374 Enrollment ID: I20041012000882 |
| Provider Name | Namita G Patel |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1205818044 PECOS PAC ID: 5395816359 Enrollment ID: I20080630000556 |
| Provider Name | Rebecca Jane White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629358056 PECOS PAC ID: 1759541568 Enrollment ID: I20120330000610 |
| Provider Name | Nirupama A Natarajan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942411251 PECOS PAC ID: 4486800083 Enrollment ID: I20120815000176 |
| Provider Name | Michael Banov |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881771004 PECOS PAC ID: 9335399179 Enrollment ID: I20121101000230 |
| Provider Name | Joshua D Morris |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417192360 PECOS PAC ID: 9436305075 Enrollment ID: I20140916001023 |
| Provider Name | Erika C Kang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639568066 PECOS PAC ID: 2163740911 Enrollment ID: I20150408000610 |
| Provider Name | Michael J Rosen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1336285261 PECOS PAC ID: 4385730183 Enrollment ID: I20160329001838 |
| Provider Name | Marla Y Fleming |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881010122 PECOS PAC ID: 6507151750 Enrollment ID: I20160826000807 |
| Provider Name | Charles D Barton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881688505 PECOS PAC ID: 0143229039 Enrollment ID: I20171127002278 |
| Provider Name | Kimberly Lanier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144558404 PECOS PAC ID: 8224376074 Enrollment ID: I20190220003230 |
| Provider Name | Brittany Clarke Toliver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235694696 PECOS PAC ID: 4082048921 Enrollment ID: I20191230002286 |
| Provider Name | Lea Morelle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427030014 PECOS PAC ID: 9537138375 Enrollment ID: I20240129002421 |
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