Provider Demographics
NPI:1841379740
Name:CENTER FOR FAMILY PSYCHIATRY
Entity Type:Organization
Organization Name:CENTER FOR FAMILY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KALIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHARGAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-486-1011
Mailing Address - Street 1:120 HANDLEY RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2177
Mailing Address - Country:US
Mailing Address - Phone:770-486-1011
Mailing Address - Fax:770-486-1067
Practice Address - Street 1:120 HANDLEY RD
Practice Address - Street 2:SUITE 310
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2177
Practice Address - Country:US
Practice Address - Phone:770-486-1011
Practice Address - Fax:770-486-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003177101YM0800X
GALPC003153101YP2500X
GAPSY002096103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA076097468AMedicaid