| Resilient Minds Psychiatric Care Of Middle Georgia Llc | |
|
110 Kellwood Dr Ste 220a Perry GA 31069-3263 | |
| (478) 300-7020 | |
| (478) 395-5221 |
| Full Name | Resilient Minds Psychiatric Care Of Middle Georgia Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 110 Kellwood Dr Ste 220a, Perry, Georgia |
| Authorized Official Name and Position | Tyler Russell Purvis (OWNER) |
| Authorized Official Contact | 4783007020 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Resilient Minds Psychiatric Care Of Middle Georgia Llc 110 Kellwood Dr Ste 220a Perry GA 31069-3263 Ph: (478) 300-7020 | Resilient Minds Psychiatric Care Of Middle Georgia Llc 110 Kellwood Dr Ste 220a Perry GA 31069-3263 Ph: (478) 300-7020 |
| NPI Number | 1871272765 |
|---|---|
| Provider Enumeration Date | 07/17/2023 |
| Last Update Date | 11/09/2023 |
| Certification Date | 11/09/2023 |
| Medicare PECOS PAC ID | 7012379423 |
|---|---|
| Medicare Enrollment ID | O20230817000773 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871272765 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Tyler Purvis |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164996104 PECOS PAC ID: 5991035628 Enrollment ID: I20230912003084 |
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