Provider Demographics
NPI:1376304402
Name:A NEW YOU PSYCHIATRIC CARE
Entity type:Organization
Organization Name:A NEW YOU PSYCHIATRIC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:SHEA
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:478-496-4896
Mailing Address - Street 1:135 MACON WEST DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5652
Mailing Address - Country:US
Mailing Address - Phone:478-496-4896
Mailing Address - Fax:478-389-0204
Practice Address - Street 1:135 MACON WEST DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5652
Practice Address - Country:US
Practice Address - Phone:478-496-4896
Practice Address - Fax:478-389-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty