Provider Demographics
NPI:1972745925
Name:PSYCHIATRIC ASSOCIATES OF LAWRENCEBURG PLLC
Entity Type:Organization
Organization Name:PSYCHIATRIC ASSOCIATES OF LAWRENCEBURG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-762-6373
Mailing Address - Street 1:1331 S LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4040
Mailing Address - Country:US
Mailing Address - Phone:931-762-6373
Mailing Address - Fax:931-762-7421
Practice Address - Street 1:1331 S LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4040
Practice Address - Country:US
Practice Address - Phone:931-762-6373
Practice Address - Fax:931-762-7421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN339752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty