Healthcare Provider Details

I. General information

NPI: 1811413305
Provider Name (Legal Business Name): EMPOWER PSYCHIATRY & SLEEP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2017
Last Update Date: 08/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 JOHNS CREEK PKWY STE 200
SUWANEE GA
30024-1286
US

IV. Provider business mailing address

3651 PEACHTREE PKWY STE E-359
SUWANEE GA
30024-6034
US

V. Phone/Fax

Practice location:
  • Phone: 717-482-1130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number77783
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number77783
License Number StateGA

VIII. Authorized Official

Name: RAVI KUMAR R SINGAREDDY
Title or Position: SOLE PROVIDER
Credential: MD
Phone: 717-482-1130