Provider Demographics
NPI:1952913345
Name:PROVIDENCE PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:PROVIDENCE PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:FU
Authorized Official - Last Name:LIUSONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-881-1500
Mailing Address - Street 1:86 TIMBER CREEK DR STE 3
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4284
Mailing Address - Country:US
Mailing Address - Phone:901-881-1500
Mailing Address - Fax:
Practice Address - Street 1:86 TIMBER CREEK DR STE 3
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-4284
Practice Address - Country:US
Practice Address - Phone:901-881-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty