MEDICARE: SOUTHERN PSYCHIATRIC PRACTICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578807483
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN PSYCHIATRIC PRACTICE

Provider Business Mailing Address
First Line	:	2424 INDIA HOOK RD
Second Line	:	STE 120
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2784
Country	:	US
Telephone Number	:	803-328-8255
Fax Number	:	803-328-8265

Provider Business Practice Location Address
First Line	:	2424 INDIA HOOK RD
Second Line	:	STE 120
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2784
Country	:	US
Telephone Number	:	803-328-8255
Fax Number	:	803-328-8265

Authorized Official
Title or Position	:	OWNER
Name	:	TAMMY T CHEN
Credential	:	MD
Telephone Number	:	803-328-8255

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

Similar Medicare Providers

1013055706 — DR. TAMMY T CHEN M.D.
Practice Location Address:

2424 INDIA HOOK RD , SUITE 120
ROCK HILL, SC
29732-2784

Practice Phone: 803-328-8255
Practice Fax: 803-328-8265

1952588345 — JANICE H HAGE APRN-BC
Practice Location Address:

2424 INDIA HOOK RD , SUITE 120
ROCK HILL, SC
29732-2784

Practice Phone: 803-328-8255
Practice Fax: 803-328-8265

1902285810 — AT HOME WITH A VIEW LLC DBA RIGHT AT HOME
Practice Location Address:

2424 INDIA HOOK RD , SUITE 130
ROCK HILL, SC
29732-2784

Practice Phone: 803-980-4663
Practice Fax:

1972053759 — PSYCHOLOGICAL MANAGEMENT SERVICES
Practice Location Address:

2424 INDIA HOOK RD , SUITE 100
ROCK HILL, SC
29732-2784

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Practice Fax:

1467038828 — FAITH & FLY PSYCHIATRIC PRACTICE, LLC
Practice Location Address:

2424 INDIA HOOK RD
ROCK HILL, SC
29732-2784

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Practice Fax:

1396597662 — DANIELLE CALVERT
Practice Location Address:

2784 FAITH BLVD
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29730-9093

Practice Phone: 843-325-3218
Practice Fax:

Directions to “SOUTHERN PSYCHIATRIC PRACTICE ” Practice Location

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