Healthcare Provider Details

I. General information

NPI: 1245648617
Provider Name (Legal Business Name): SOUTH CENTRAL GENERAL AND GERIATRIC PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8651 JAFFA COURT EAST DR APT 11
INDIANAPOLIS IN
46260-5329
US

IV. Provider business mailing address

1305 WASHINGTON ST
HOLLYWOOD FL
33019-1812
US

V. Phone/Fax

Practice location:
  • Phone: 317-414-7372
  • Fax: 502-415-7468
Mailing address:
  • Phone: 317-414-7372
  • Fax: 502-415-7468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR LYAKHOVETSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 317-414-7372