Healthcare Provider Details

I. General information

NPI: 1033837802
Provider Name (Legal Business Name): TRANQUILITY TELEPSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W ANDERSON ST
SAVANNAH GA
31401
US

IV. Provider business mailing address

PO BOX 181
SAVANNAH GA
31402-0181
US

V. Phone/Fax

Practice location:
  • Phone: 206-761-6046
  • Fax: 206-761-6047
Mailing address:
  • Phone: 206-761-6046
  • Fax: 201-761-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JABARI DOBSON
Title or Position: OWNER
Credential: PMHNP
Phone: 206-761-6046