Provider Demographics
NPI:1578026431
Name:SOUTH ATLANTA PSYCHIATRY LLC
Entity Type:Organization
Organization Name:SOUTH ATLANTA PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLIPAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-876-2789
Mailing Address - Street 1:253 UPPER RIVERDALE RD SW STE C
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4945
Mailing Address - Country:US
Mailing Address - Phone:770-876-2789
Mailing Address - Fax:
Practice Address - Street 1:253 UPPER RIVERDALE RD SW STE C
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4945
Practice Address - Country:US
Practice Address - Phone:770-876-2789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit