Provider Demographics
NPI:1578839668
Name:ST. MARYS PSYCHIATRY, INC.
Entity Type:Organization
Organization Name:ST. MARYS PSYCHIATRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-576-6800
Mailing Address - Street 1:4445 HWY 40
Mailing Address - Street 2:SUITE 601
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4099
Mailing Address - Country:US
Mailing Address - Phone:912-576-6800
Mailing Address - Fax:
Practice Address - Street 1:4445 HWY 40
Practice Address - Street 2:SUITE 601
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4099
Practice Address - Country:US
Practice Address - Phone:912-576-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58799261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDKQGMedicare UPIN