Georgia Psych Services LLC

Organization Active NPI Psychiatric/Mental Health Nurse Practitioner · Locust Grove, GA

NPI 1245801075 · NPPES record last updated Aug 24, 2021

Key facts

NPI
1245801075
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Legal business name
GEORGIA PSYCH SERVICES LLC
Practice address
4922 Bill Gardner Pkwy # 2
Locust Grove, GA 30248-3647
Phone
(330) 536-3746
Fax
(330) 267-4250
NPI assigned
Jul 2, 2021
Organization subpart
No

Authorized official

Name
Robert Sean Rae, MD
Title
Ceo
Phone
(330) 536-3746

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: amyp@psych360.org

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner
Group: 193400000X SINGLE SPECIALTY GROUP
363L00000X
Psychiatric/Mental Health Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP
363LP0808X Yes

Addresses

Primary practice location

4922 Bill Gardner Pkwy # 2
Locust Grove, GA 30248-3647

Mailing address

3593 Medina Line Rd 181
Medina, OH 44256
Phone (330) 664-9250

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address AMYP@PSYCH360.ORG Health Information Exchange (HIE)

Other providers in Locust Grove, GA

All providers in Locust Grove, GA · Psychiatric/Mental Health Nurse Practitioner in Georgia

Sources for this page

Verify at the official NPI Registry.