| Ravens Nest Foundation Inc | |
|
3875 Austell Rd Ste 303 Austell GA 30106-1153 | |
| (770) 819-6825 | |
| (770) 819-6826 |
| Full Name | Ravens Nest Foundation Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3875 Austell Rd Ste 303, Austell, Georgia |
| Authorized Official Name and Position | Shelby Green (CEO) |
| Authorized Official Contact | 7708196825 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ravens Nest Foundation Inc Po Box 813683 Smyrna GA 30081-8683 Ph: (678) 214-6572 | Ravens Nest Foundation Inc 3875 Austell Rd Ste 303 Austell GA 30106-1153 Ph: (770) 819-6825 |
| NPI Number | 1578867982 |
|---|---|
| Provider Enumeration Date | 12/28/2010 |
| Last Update Date | 03/27/2020 |
| Certification Date | 03/27/2020 |
| Medicare PECOS PAC ID | 8921429986 |
|---|---|
| Medicare Enrollment ID | O20200528003058 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578867982 | NPI | - | NPPES |
| 003111706A | Medicaid | GA |
| Provider Name | Martin Thomas Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760784839 PECOS PAC ID: 7416190947 Enrollment ID: I20130830000269 |
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