Healthcare Provider Details

I. General information

NPI: 1508087792
Provider Name (Legal Business Name): PSYCHIATRIC SERVICES OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 GWINNETT DR.
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

311 GWINNETT DR
LAWRENCEVILLE GA
30046-5629
US

V. Phone/Fax

Practice location:
  • Phone: 770-910-9196
  • Fax: 770-910-9197
Mailing address:
  • Phone: 770-910-9196
  • Fax: 770-910-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number053239
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHZAD HASMI
Title or Position: CMO
Credential: MD
Phone: 770-910-9196