Sullivan Psychiatric SVCS LLC

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

047162 Issued in GA

Legal business name

SULLIVAN PSYCHIATRIC SVCS LLC

Practice address

425 Allgood Rd
Stone Mountain, GA 30083-6145

Phone

(404) 508-3822

Fax

(404) 508-3823

NPI assigned

Sep 28, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Raina Sullivan, MD

Title

Owner

Phone

(404) 508-3822

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1164756839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 ALLGOOD RD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300836145",
            "telephone_number": "404-508-3822",
            "fax_number": "404-508-3823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 ALLGOOD RD",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300836145",
            "telephone_number": "404-508-3822",
            "fax_number": "404-508-3823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SULLIVAN PSYCHIATRIC SVCS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-28",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "RAINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-508-3822",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "GA",
            "license": "047162",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "343324511A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Child & Adolescent Psychiatry Physician in Stone Mountain, GA
• Providers in Stone Mountain, GA by specialty
• Child & Adolescent Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.