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
- amyp@psych360.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | AMYP@PSYCH360.ORG | Health Information Exchange (HIE) |
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All providers in Locust Grove, GA · Psychiatric/Mental Health Nurse Practitioner in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.