Provider Demographics
NPI:1508087792
Name:PSYCHIATRIC SERVICES OF AMERICA
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HASMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-910-9196
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:770-714-8822
Mailing Address - Fax:770-277-3341
Practice Address - Street 1:311 GWINNETT DR.
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046
Practice Address - Country:US
Practice Address - Phone:770-910-9196
Practice Address - Fax:770-910-9197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
GA0532392084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDJRLMedicare ID - Type Unspecified