Provider Demographics
NPI:1740683309
Name:PSYCHIATRIC NP SERVICES
Entity type:Organization
Organization Name:PSYCHIATRIC NP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:SAPP
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:478-284-1116
Mailing Address - Street 1:5228 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2902
Mailing Address - Country:US
Mailing Address - Phone:478-284-1116
Mailing Address - Fax:
Practice Address - Street 1:5228 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2902
Practice Address - Country:US
Practice Address - Phone:478-284-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN063812363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN063812OtherLICENSE NUMBER
GA2008002521OtherADVANCED PRACTICE ANCC CERTIFICATION