Provider Demographics
NPI:1598149114
Name:CAROLINA CHILD PSYCHIATRIC SERVICES, PA
Entity Type:Organization
Organization Name:CAROLINA CHILD PSYCHIATRIC SERVICES, PA
Other - Org Name:NEW GARDEN PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANARDHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONNALAGADDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-541-8111
Mailing Address - Street 1:2016 NEW GARDEN RD STE C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2502
Mailing Address - Country:US
Mailing Address - Phone:336-541-8111
Mailing Address - Fax:855-427-6593
Practice Address - Street 1:2016 NEW GARDEN RD STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2502
Practice Address - Country:US
Practice Address - Phone:336-541-8111
Practice Address - Fax:855-427-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01663261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health