Psychiatry And Psychological Associates Llc | |
539 Green St Nw Gainesville GA 30501-3313 | |
(770) 718-9790 | |
(770) 718-5531 |
Full Name | Psychiatry And Psychological Associates Llc |
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Speciality | Psychologist |
Location | 539 Green St Nw, Gainesville, Georgia |
Authorized Official Name and Position | Mark L King (OWNER) |
Authorized Official Contact | 7707189790 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Psychiatry And Psychological Associates Llc 539 Green St Nw Gainesville GA 30501-3313 Ph: (770) 718-9790 | Psychiatry And Psychological Associates Llc 539 Green St Nw Gainesville GA 30501-3313 Ph: (770) 718-9790 |
NPI Number | 1124038187 |
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Provider Enumeration Date | 08/09/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 6002811197 |
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Medicare Enrollment ID | O20060925000005 |
Identifier | Type | State | Issuer |
---|---|---|---|
1124038187 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | PSY002603 (Georgia) | Primary |
Provider Name | Carol Taylor |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1699019703 PECOS PAC ID: 6103058722 Enrollment ID: I20140415000293 |
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