Provider Demographics
NPI:1891987590
Name:GEORGIA PSYCHOLOGICAL CONSULTANTS
Entity Type:Organization
Organization Name:GEORGIA PSYCHOLOGICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-428-6698
Mailing Address - Street 1:1000 WHITLOCK AVE NW
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5455
Mailing Address - Country:US
Mailing Address - Phone:770-428-6698
Mailing Address - Fax:
Practice Address - Street 1:600 KENNESAW AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6988
Practice Address - Country:US
Practice Address - Phone:770-428-6698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA999103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTRICARE
GAGRP3973Medicare UPIN
GA68BBFXVMedicare UPIN