Provider Demographics
NPI:1629088984
Name:PSYCHIATRIC CONSULTANTS OF ATLANTA
Entity Type:Organization
Organization Name:PSYCHIATRIC CONSULTANTS OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:KIRKLAND
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-234-0981
Mailing Address - Street 1:990 HAMMOND DR STE 525
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5529
Mailing Address - Country:US
Mailing Address - Phone:770-234-0981
Mailing Address - Fax:770-626-4226
Practice Address - Street 1:990 HAMMOND DR STE 525
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5529
Practice Address - Country:US
Practice Address - Phone:770-234-0981
Practice Address - Fax:770-626-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA53850261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADG1845OtherRAILROAD MEDICARE
GADG1845OtherRAILROAD MEDICARE