Provider Demographics
NPI:1659313195
Name:ATLANTA PSYCHIATRIC INSTITUTE
Entity type:Organization
Organization Name:ATLANTA PSYCHIATRIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILAKAMARRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-573-9255
Mailing Address - Street 1:PO BOX 27270
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-7270
Mailing Address - Country:US
Mailing Address - Phone:478-405-5880
Mailing Address - Fax:478-405-5992
Practice Address - Street 1:5400 LAUREL SPRINGS PKWY
Practice Address - Street 2:UNIT 602
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6056
Practice Address - Country:US
Practice Address - Phone:770-573-9255
Practice Address - Fax:770-573-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2056OtherMEDICARE GROUP NUMBER