Provider Demographics
NPI:1982813697
Name:AUGUSTA AREA PSYCHIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:AUGUSTA AREA PSYCHIATRIC ASSOCIATES
Other - Org Name:BRIGHTMORE OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:THOMPSON
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:OFFICE MANAGER
Authorized Official - Phone:706-855-8866
Mailing Address - Street 1:1505 WINTER ST
Mailing Address - Street 2:BLDG C
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4819
Mailing Address - Country:US
Mailing Address - Phone:706-855-8866
Mailing Address - Fax:706-860-6358
Practice Address - Street 1:1505 WINTER ST
Practice Address - Street 2:BLDG C
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4819
Practice Address - Country:US
Practice Address - Phone:706-855-8866
Practice Address - Fax:706-860-6358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025106103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
87Medicare ID - Type UnspecifiedME