Healthcare Provider Details

I. General information

NPI: 1114880127
Provider Name (Legal Business Name): FAITH PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 ROSS AVE
MILLEN GA
30442-1709
US

IV. Provider business mailing address

650 ROSS AVE
MILLEN GA
30442-1709
US

V. Phone/Fax

Practice location:
  • Phone: 706-755-5243
  • Fax:
Mailing address:
  • Phone: 706-755-5243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MARY L DEVAUL- ESHLAMAN
Title or Position: OWNER
Credential: DO
Phone: 706-755-5243