Healthcare Provider Details
I. General information
NPI: 1447859608
Provider Name (Legal Business Name): SUNLIGHT PSYCHIATRIC SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2300 13TH ST APT C
COLUMBUS GA
31906-2182
US
IV. Provider business mailing address
PO BOX 8766
COLUMBUS GA
31908-8766
US
V. Phone/Fax
- Phone: 706-464-5490
- Fax: 706-243-3409
- Phone: 706-464-5490
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 2084P0804X |
| Taxonomy | Child & Adolescent Psychiatry Physician |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
VIII. Authorized Official
Name: DR.
BRETT
NICOLE
MURPHY-DAWSON
Title or Position: CEO
Credential: MD
Phone: 706-464-5490