| Psychogenesis, Inc. | |
|
519 Broad St Suite 202 Rome GA 30161-1734 | |
| (706) 232-5544 | |
| (888) 543-1173 |
| Full Name | Psychogenesis, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 519 Broad St, Rome, Georgia |
| Authorized Official Name and Position | Judith Tutin (PRESIDENT) |
| Authorized Official Contact | 7062325544 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychogenesis, Inc. 2 Windsor Rd Sw Rome GA 30165-8555 Ph: (706) 232-5544 | Psychogenesis, Inc. 519 Broad St Suite 202 Rome GA 30161-1734 Ph: (706) 232-5544 |
| NPI Number | 1083779763 |
|---|---|
| Provider Enumeration Date | 12/24/2006 |
| Last Update Date | 12/03/2015 |
| Medicare PECOS PAC ID | 0547435182 |
|---|---|
| Medicare Enrollment ID | O20111212000048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083779763 | NPI | - | NPPES |
| 000728923A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 2075 (Georgia) | Primary |
| Provider Name | Judith Tutin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1265597942 PECOS PAC ID: 0446425987 Enrollment ID: I20111212000096 |
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