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General NPI Number Information
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NPI Number | 1194129544
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC SERVICES AT BROOKSTONE, PC
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 2263 BROOKSTONE CENTRE PKWY STE C
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City | COLUMBUS
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State | GA
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Zip | 31904-4650
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Country | US
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Telephone | 706-341-4060
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Fax | 706-341-4061
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Provider Business Mailing Address
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Address Line | 2263 BROOKSTONE CENTRE PKWY STE C
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City | COLUMBUS
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State | GA
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Zip | 31904-4650
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Country | US
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Telephone | 706-341-4060
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Fax | 706-341-4061
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEVIN MCPHERSON
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Credential | MD
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Telephone | 706-341-4060
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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 | 65152
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License Number State | GA
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