Provider Demographics
NPI:1437888740
Name:PHOENIX RISING PSYCHIATRIC, RECOVERY & SLEEP SERVICES
Entity Type:Organization
Organization Name:PHOENIX RISING PSYCHIATRIC, RECOVERY & SLEEP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GINARI
Authorized Official - Middle Name:GIBB
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-709-9021
Mailing Address - Street 1:101 DEVANT ST STE 504
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2720
Mailing Address - Country:US
Mailing Address - Phone:770-282-6962
Mailing Address - Fax:770-282-6983
Practice Address - Street 1:101 DEVANT ST STE 504
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2720
Practice Address - Country:US
Practice Address - Phone:770-282-6962
Practice Address - Fax:770-282-6983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000000000000000000OtherDO NOT HAVE THESE NUMBERS YET