Healthcare Provider Details

I. General information

NPI: 1245919430
Provider Name (Legal Business Name): ABUNDANT LIFE PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 HIGHWAY 441 S STE 2
CLAYTON GA
30525-5435
US

IV. Provider business mailing address

621 HWY 441 SOUTH UNIT 2
CLAYTON GA
30525-0030
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-4485
  • Fax: 762-212-4368
Mailing address:
  • Phone: 706-613-4485
  • Fax: 762-212-4368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH RACADAG
Title or Position: OFFICE MANAGER/CO-OWNER
Credential: BSN-RN
Phone: 706-613-4485