Provider Demographics
NPI:1518277979
Name:ALPHARETTA PSYCHIATRIC ASSOC., P.C.
Entity Type:Organization
Organization Name:ALPHARETTA PSYCHIATRIC ASSOC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:BEHR
Authorized Official - Last Name:WOLFBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-664-6229
Mailing Address - Street 1:1040 CAMBRIDGE SQ
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1800
Mailing Address - Country:US
Mailing Address - Phone:770-664-6229
Mailing Address - Fax:770-664-6684
Practice Address - Street 1:1040 CAMBRIDGE SQ
Practice Address - Street 2:SUITE D
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1800
Practice Address - Country:US
Practice Address - Phone:770-664-6229
Practice Address - Fax:770-664-6684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034744261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
C87246Medicare UPIN