Provider Demographics
NPI:1912574732
Name:PSYCH CARE ATL
Entity Type:Organization
Organization Name:PSYCH CARE ATL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIHERA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:770-841-4440
Mailing Address - Street 1:2801 BUFORD HWY NE STE 540
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2143
Mailing Address - Country:US
Mailing Address - Phone:770-841-4440
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY NE STE 540
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2143
Practice Address - Country:US
Practice Address - Phone:770-841-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty