Lighthorse Psychiatry LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

RN044413 Issued in GA

Legal business name

LIGHTHORSE PSYCHIATRY LLC

Practice address

102 Lakeshore Dr Ste B
Saint Marys, GA 31558-3875

Phone

(912) 882-3800

Fax

(912) 882-3303

NPI assigned

Apr 6, 2017

Organization subpart

No

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

Authorized official

Name

Nina C Leonard, APRNNPI 1679877526

Title

Aprn

Phone

(912) 673-9907

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nina Coleman Leonard, CPNP-PC, PMHCNS-BC

  • Nurse Practitioner
  • Saint Marys, GA
  • NPI 1679877526

  GA

  Medicare reassignment NPD Authorized official
• Srinivas Kolipaka, MD

  • Psychiatry Physician
  • Canton, GA
  • NPI 1831381433
  NPD
• Ujwal Siddamreddy, M.D.

  • Psychiatry Physician
  • Dalton, GA
  • NPI 1952463747
  NPD
• Nannette M Brannon, LPC

  • Professional Counselor
  • St. Marys, GA
  • NPI 1841446663
  NPD (past)
• Megan E. Lavery, LPC

  • Mental Health Counselor
  • Saint Marys, GA
  • NPI 1154859957
  NPD (past)

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606867200000",
    "number": "1699208777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 LAKESHORE DR STE B",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583875",
            "telephone_number": "912-882-3800",
            "fax_number": "912-882-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 LAKESHORE DR STE B",
            "city": "SAINT MARYS",
            "state": "GA",
            "postal_code": "315583875",
            "telephone_number": "912-882-3800",
            "fax_number": "912-882-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHORSE PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-06",
        "last_updated": "2020-12-02",
        "certification_date": "2020-12-02",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "NINA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "APRN",
        "authorized_official_telephone_number": "912-673-9907",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "RN044413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica Lewis
• Carla Ann Leyen, MSPT, MOMT
• Life Line Home Care Inc
• Light Horse Healthcare Inc
• Lighthorse Healthcare, Inc.
• Roberta Lindau, LCSW
• John-Henry Lipian, AA
• Little Bridges Speech Therapy, LLC.
• Longevity Care Services Inc
• Madison Longley

• All providers in Saint Marys, GA
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.