Provider Demographics
NPI:1336730936
Name:PSYCH CENTERS OF GEORGIA LLC
Entity Type:Organization
Organization Name:PSYCH CENTERS OF GEORGIA LLC
Other - Org Name:NEUROPSYCH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD ADVISOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-538-9314
Mailing Address - Street 1:368 W PIKE ST STE 105A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3240
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:368 W PIKE ST STE 105A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3240
Practice Address - Country:US
Practice Address - Phone:678-203-8802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-27
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty