Healthcare Provider Details

I. General information

NPI: 1073994737
Provider Name (Legal Business Name): CA RMH PHYSICIAN SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 09/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23823 MALIBU RD # 50-386
MALIBU CA
90265-4628
US

IV. Provider business mailing address

2300 WINDY RIDGE PKWY SE STE 210
ATLANTA GA
30339-5665
US

V. Phone/Fax

Practice location:
  • Phone: 800-366-8101
  • Fax: 561-697-4345
Mailing address:
  • Phone: 800-366-8101
  • Fax: 561-697-4345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: JEAN A DOCKERY
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 561-253-4149