Provider Demographics
NPI:1689725756
Name:PSYCHIATRIC & COUNSELING SERVICES OF COFFEE COUNTY
Entity Type:Organization
Organization Name:PSYCHIATRIC & COUNSELING SERVICES OF COFFEE COUNTY
Other - Org Name:KARUNA REDDY, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARUNA
Authorized Official - Middle Name:DYAPA
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-383-8806
Mailing Address - Street 1:303A SHIRLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2333
Mailing Address - Country:US
Mailing Address - Phone:912-383-8806
Mailing Address - Fax:912-383-8147
Practice Address - Street 1:303A SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2333
Practice Address - Country:US
Practice Address - Phone:912-383-8806
Practice Address - Fax:912-383-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0295192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000399814HMedicaid
GA000399814HMedicaid
GAGRP4341Medicare ID - Type Unspecified