Sullivan Psychiatric Svcs Llc | |
425 Allgood Rd Stone Mountain GA 30083-6145 | |
(404) 508-3822 | |
(404) 508-3823 |
Full Name | Sullivan Psychiatric Svcs Llc |
---|---|
Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
Location | 425 Allgood Rd, Stone Mountain, Georgia |
Authorized Official Name and Position | Raina Sullivan (OWNER) |
Authorized Official Contact | 4045083822 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Sullivan Psychiatric Svcs Llc 425 Allgood Rd Stone Mountain GA 30083-6145 Ph: (404) 508-3822 | Sullivan Psychiatric Svcs Llc 425 Allgood Rd Stone Mountain GA 30083-6145 Ph: (404) 508-3822 |
NPI Number | 1164756839 |
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Provider Enumeration Date | 09/28/2009 |
Last Update Date | 09/28/2009 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164756839 | NPI | - | NPPES |
343324511A | Medicaid | GA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 047162 (Georgia) | Primary |
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