Healthcare Provider Details

I. General information

NPI: 1952443020
Provider Name (Legal Business Name): MEDPSYCH SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 RIVERSIDE PKWY NE SUITE 300
ROME GA
30161-2982
US

IV. Provider business mailing address

P.O. BOX 3207
ROME GA
30164-3207
US

V. Phone/Fax

Practice location:
  • Phone: 706-290-0535
  • Fax:
Mailing address:
  • Phone: 706-290-0535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPSY002010
License Number StateGA

VIII. Authorized Official

Name: DR. JOHN SCOTT BARANCHOK
Title or Position: OWNER
Credential: PHD
Phone: 706-290-0535