Provider Demographics
NPI:1629330154
Name:YOUNG MINDS PSYCHIATRY, LC
Entity Type:Organization
Organization Name:YOUNG MINDS PSYCHIATRY, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALKHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-615-7032
Mailing Address - Street 1:750 HAMMOND DRIVE
Mailing Address - Street 2:BLG 14 SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6520
Mailing Address - Country:US
Mailing Address - Phone:678-615-7032
Mailing Address - Fax:
Practice Address - Street 1:750 HAMMOND DRIVE
Practice Address - Street 2:BUILDING 14 SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-615-7032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA655602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003119089CMedicaid