Provider Demographics
NPI:1093456048
Name:PSYCLE DOC LLC
Entity Type:Organization
Organization Name:PSYCLE DOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-850-3061
Mailing Address - Street 1:4780 TALL PINES DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3328
Mailing Address - Country:US
Mailing Address - Phone:208-850-3061
Mailing Address - Fax:
Practice Address - Street 1:755 MOUNT VERNON HWY NE STE 220
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4277
Practice Address - Country:US
Practice Address - Phone:208-850-3061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty