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101 Quartz Dr Suite 103 Villa Rica GA 30180-3255 | |
| (770) 456-3722 | |
| (770) 456-3739 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 101 Quartz Dr, Villa Rica, Georgia |
| Authorized Official Name and Position | Debbi Macaluso-peare (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7708388554 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
101 Quartz Dr Suite 103 Villa Rica GA 30180-3255 Ph: (770) 456-3722 | 101 Quartz Dr Suite 103 Villa Rica GA 30180-3255 Ph: (770) 456-3722 |
| NPI Number | 1588679203 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 05/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588679203 | NPI | - | NPPES |
| DA2102 | Other | GA | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 035853 (Georgia) | Primary |
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