Provider Demographics
NPI:1952443020
Name:MEDPSYCH SERVICES, PC
Entity Type:Organization
Organization Name:MEDPSYCH SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BARANCHOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-290-0535
Mailing Address - Street 1:P.O. BOX 3207
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30164-3207
Mailing Address - Country:US
Mailing Address - Phone:706-290-0535
Mailing Address - Fax:
Practice Address - Street 1:504 RIVERSIDE PKWY NE
Practice Address - Street 2:SUITE 300
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-2982
Practice Address - Country:US
Practice Address - Phone:706-290-0535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002010174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000793174CMedicaid
GA000793174CMedicaid