Provider Demographics
NPI:1356660898
Name:GEORGIA PSYCHIATRIC AND ADDICTION CLINIC P.C.
Entity Type:Organization
Organization Name:GEORGIA PSYCHIATRIC AND ADDICTION CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:229-439-8686
Mailing Address - Street 1:1211 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1935
Mailing Address - Country:US
Mailing Address - Phone:229-439-8686
Mailing Address - Fax:229-883-4484
Practice Address - Street 1:1211 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1935
Practice Address - Country:US
Practice Address - Phone:229-439-8686
Practice Address - Fax:229-883-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0315772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000463526LMedicaid