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General NPI Number Information
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NPI Number | 1003039215
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Entity Type | Organization
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Legal Business Name | CITY TO CITY PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4163 IDLEWOOD PARC CT
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City | TUCKER
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State | GA
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Zip | 30084-7833
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Country | US
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Telephone | 678-637-5216
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Fax |
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Provider Business Mailing Address
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Address Line | 4163 IDLEWOOD PARC CT
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City | TUCKER
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State | GA
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Zip | 30084-7833
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Country | US
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Telephone | 678-637-5216
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Fax |
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Authorized Official
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Title or Position | CEO-CHILD & ADOLESCENT PSYCHIATRIST
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Name | DR. KEISHA BROWN
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Credential | M.D.
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Telephone | 678-637-5216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 048985
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License Number State | GA
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