| Psych Practice Llc | |
|
410 Shirley Ave Douglas GA 31533-2002 | |
| (912) 260-1206 | |
| (912) 383-7820 |
| Full Name | Psych Practice Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 410 Shirley Ave, Douglas, Georgia |
| Authorized Official Name and Position | Mubbashir M Khan (CEO/ M.D) |
| Authorized Official Contact | 9122601206 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Psych Practice Llc 410 Shirley Ave Douglas GA 31533-2002 Ph: (912) 260-1206 | Psych Practice Llc 410 Shirley Ave Douglas GA 31533-2002 Ph: (912) 260-1206 |
| NPI Number | 1689060790 |
|---|---|
| Provider Enumeration Date | 04/15/2015 |
| Last Update Date | 04/15/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689060790 | NPI | - | NPPES |
| 003120037D | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 054327 (Georgia) | Primary |
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