Healthcare Provider Details

I. General information

NPI: 1518896216
Provider Name (Legal Business Name): PSYCHIATRIC CONSULTANTS WELLNESS OF ATLANTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 MILL GROVE LN SW
SMYRNA GA
30082-4539
US

IV. Provider business mailing address

4220 MILL GROVE LN SW
SMYRNA GA
30082-4539
US

V. Phone/Fax

Practice location:
  • Phone: 678-294-3109
  • Fax:
Mailing address:
  • Phone: 678-294-3109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELIZABETH NORMAN
Title or Position: DIRECTOR/MGR
Credential: MSW
Phone: 678-294-3109