Provider Demographics
NPI:1407041858
Name:SOLURSH PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:SOLURSH PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SOLURSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-733-7029
Mailing Address - Street 1:2301 WRIGHTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6219
Mailing Address - Country:US
Mailing Address - Phone:706-733-7029
Mailing Address - Fax:706-733-1376
Practice Address - Street 1:2301 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6219
Practice Address - Country:US
Practice Address - Phone:706-733-7029
Practice Address - Fax:706-733-1376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBGCLMedicare UPIN