Provider Demographics
NPI:1568887768
Name:PSIHAS, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:PSIHAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 FERST DR NW SUITE 207
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30332-0001
Mailing Address - Country:US
Mailing Address - Phone:404-480-7307
Mailing Address - Fax:
Practice Address - Street 1:740 FERST DR NW SUITE 207
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30332-7041
Practice Address - Country:US
Practice Address - Phone:404-480-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014148271223G0001X
390200000X
GADN1226441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program