Provider Demographics
NPI:1679589485
Name:SUMTER PSYCHIATRY ASSOCIATES PA
Entity Type:Organization
Organization Name:SUMTER PSYCHIATRY ASSOCIATES PA
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTON
Authorized Official - Middle Name:H
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-236-3199
Mailing Address - Street 1:315 HAYNSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4005
Mailing Address - Country:US
Mailing Address - Phone:803-236-3958
Mailing Address - Fax:
Practice Address - Street 1:315 HAYNSWORTH ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4005
Practice Address - Country:US
Practice Address - Phone:803-236-3958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3142Medicaid
SC6386Medicare ID - Type Unspecified