Provider Demographics
NPI:1417938366
Name:KARASIEVICH, GEORGE O (PSY D)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:O
Last Name:KARASIEVICH
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 REED RD STE 104
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-6307
Mailing Address - Country:US
Mailing Address - Phone:706-529-8710
Mailing Address - Fax:706-529-8715
Practice Address - Street 1:475 REED RD STE 104
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-6307
Practice Address - Country:US
Practice Address - Phone:706-529-8710
Practice Address - Fax:706-529-8715
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY 00637103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00150224CMedicaid
GA00150224CMedicaid
R08847Medicare UPIN