Provider Demographics
NPI:1649947904
Name:BMD TELEPSYCHIATRY LLC
Entity type:Organization
Organization Name:BMD TELEPSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:D'ORIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-358-2209
Mailing Address - Street 1:1360 CADUCEUS WAY
Mailing Address - Street 2:BLDG 400, STE 102
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677
Mailing Address - Country:US
Mailing Address - Phone:678-358-2209
Mailing Address - Fax:
Practice Address - Street 1:1360 CADUCEUS WAY
Practice Address - Street 2:BLDG 400, STE 102
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:678-358-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-25
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0054240743Medicaid