Provider Demographics
NPI:1245648617
Name:SOUTH CENTRAL GENERAL AND GERIATRIC PSYCHIATRY PC
Entity type:Organization
Organization Name:SOUTH CENTRAL GENERAL AND GERIATRIC PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:LYAKHOVETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-414-7372
Mailing Address - Street 1:1305 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-1812
Mailing Address - Country:US
Mailing Address - Phone:317-414-7372
Mailing Address - Fax:502-415-7468
Practice Address - Street 1:8651 JAFFA COURT EAST DR APT 11
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5329
Practice Address - Country:US
Practice Address - Phone:317-414-7372
Practice Address - Fax:502-415-7468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty