Healthcare Provider Details

I. General information

NPI: 1467363978
Provider Name (Legal Business Name): PSYCHIATRIC CARE OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 PARKLAKE DR NE
ATLANTA GA
30345-2913
US

IV. Provider business mailing address

1201 W PEACHTREE ST NW
ATLANTA GA
30309-3449
US

V. Phone/Fax

Practice location:
  • Phone: 800-423-9991
  • Fax: 470-523-4429
Mailing address:
  • Phone: 800-423-9991
  • Fax: 470-523-4429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHATRECE JENKINS
Title or Position: ORGANIZER
Credential:
Phone: 800-423-9991