Provider Demographics
NPI:1467040410
Name:SOUTHEAST PSYCHIATRY SERVICES, LLC
Entity Type:Organization
Organization Name:SOUTHEAST PSYCHIATRY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-315-7478
Mailing Address - Street 1:182 BOYKIN LAKES LOOP
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-3961
Mailing Address - Country:US
Mailing Address - Phone:706-315-7478
Mailing Address - Fax:
Practice Address - Street 1:182 BOYKIN LAKES LOOP
Practice Address - Street 2:
Practice Address - City:PIKE ROAD
Practice Address - State:AL
Practice Address - Zip Code:36064-3961
Practice Address - Country:US
Practice Address - Phone:706-315-7478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty