Healthcare Provider Details

I. General information

NPI: 1598042111
Provider Name (Legal Business Name): ADRIAN JANIT PSYCHLSVCS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730B EXECUTIVE CENTER DR
AUGUSTA GA
30907-2360
US

IV. Provider business mailing address

3730B EXECUTIVE CENTER DR
AUGUSTA GA
30907-2360
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-4599
  • Fax: 706-364-4589
Mailing address:
  • Phone: 706-364-4599
  • Fax: 706-364-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY003347
License Number StateGA

VIII. Authorized Official

Name: MRS. SHEREE MEYERS
Title or Position: OFFICE MANAGER
Credential:
Phone: 706-364-7165