Healthcare Provider Details

I. General information

NPI: 1588727978
Provider Name (Legal Business Name): PSYCHIATRIC CONSULTATIVE SERVICES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 ASHFORD DUNWOODY RD SUITE A 226
ATLANTA GA
30338-5504
US

IV. Provider business mailing address

4780 ASHFORD DUNWOODY RD SUITE A 226
ATLANTA GA
30338-5504
US

V. Phone/Fax

Practice location:
  • Phone: 770-265-2772
  • Fax:
Mailing address:
  • Phone: 770-265-2772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN033413
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN095208NP
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN124271
License Number StateGA

VIII. Authorized Official

Name: TAREN LAZZARI
Title or Position: PRESIDENT
Credential: CNS
Phone: 770-265-2772