Provider Demographics
NPI:1851454086
Name:SATILLA RELIANT PSYCHIATRIC SERVICES, LLC
Entity Type:Organization
Organization Name:SATILLA RELIANT PSYCHIATRIC SERVICES, LLC
Other - Org Name:SATILLA REGIONAL CENTER FOR MEMORY DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-313-0445
Mailing Address - Street 1:6 OFFICE PARK CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2512
Mailing Address - Country:US
Mailing Address - Phone:205-313-0445
Mailing Address - Fax:205-313-6545
Practice Address - Street 1:410 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5246
Practice Address - Country:US
Practice Address - Phone:912-338-6338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit