| West Georgia Psychological Services | |
|
6264 Hospital Way Douglasville GA 30134-1944 | |
| (678) 232-9078 | |
| (866) 489-2642 |
| Full Name | West Georgia Psychological Services |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 6264 Hospital Way, Douglasville, Georgia |
| Authorized Official Name and Position | Tina Marie Caudill (PSYCHOLOGIST) |
| Authorized Official Contact | 6782329078 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| West Georgia Psychological Services Po Box 1916 Douglasville GA 30133-1916 Ph: (678) 232-9078 | West Georgia Psychological Services 6264 Hospital Way Douglasville GA 30134-1944 Ph: (678) 232-9078 |
| NPI Number | 1962543579 |
|---|---|
| Provider Enumeration Date | 02/08/2007 |
| Last Update Date | 04/24/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962543579 | NPI | - | NPPES |
| 112025855C | Medicaid | GA | |
| 10071390 | Other | GA | AMERIGROUP |
| 112025855E | Medicaid | GA | |
| 112025855D | Medicaid | GA | |
| 112025855F | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 002899 (Georgia) | Primary |
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