Provider Demographics
NPI:1639377898
Name:GEORGIA CENTER FOR BIPOLAR DISORDER, PC
Entity Type:Organization
Organization Name:GEORGIA CENTER FOR BIPOLAR DISORDER, PC
Other - Org Name:MACON PAYCHIATRY CENTER PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-474-8774
Mailing Address - Street 1:PO BOX 4048
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4048
Mailing Address - Country:US
Mailing Address - Phone:478-474-8774
Mailing Address - Fax:478-474-8734
Practice Address - Street 1:3902 NORTHSIDE DR
Practice Address - Street 2:SUITE A4
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2459
Practice Address - Country:US
Practice Address - Phone:478-474-8774
Practice Address - Fax:478-474-8734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0468242084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00832378CMedicaid
GAH00678Medicare UPIN