Provider Demographics
NPI:1174847834
Name:GEORGIA PSYCHIATRIC CONSULTANTS LLC
Entity Type:Organization
Organization Name:GEORGIA PSYCHIATRIC CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PURSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-705-8166
Mailing Address - Street 1:652 BELLEMEADE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3102
Mailing Address - Country:US
Mailing Address - Phone:678-705-8166
Mailing Address - Fax:678-705-8569
Practice Address - Street 1:652 BELLEMEADE AVE NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3102
Practice Address - Country:US
Practice Address - Phone:678-705-8166
Practice Address - Fax:678-705-8569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0443122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003105773AMedicaid