Healthcare Provider Details

I. General information

NPI: 1205468840
Provider Name (Legal Business Name): ANGELA LEIGH EUBANKS MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 GOOSE HOLLOW ROAD
REYNOLDS GA
31076
US

IV. Provider business mailing address

11 S WINSTON ST
REYNOLDS GA
31076-3200
US

V. Phone/Fax

Practice location:
  • Phone: 800-885-4673
  • Fax: 800-885-4673
Mailing address:
  • Phone: 478-847-9878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN248956
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: