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General NPI Number Information
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NPI Number | 1245036573
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Entity Type | Organization
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Legal Business Name | GEORGIA PSYCHIATRY SERVICES LLC
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Dates
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Enumeration Date | 02/19/2025
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 130 N GROSS RD
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City | KINGSLAND
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State | GA
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Zip | 31548-6262
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Country | US
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Telephone | 912-208-2055
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Fax | 912-250-5813
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Provider Business Mailing Address
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Address Line | 429 EAGLE BLVD
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City | KINGSLAND
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State | GA
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Zip | 31548-6495
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Country | US
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Telephone | 912-223-2310
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Fax | 912-250-5813
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Authorized Official
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Title or Position | OWNER
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Name | MS. KELLIE KING
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Credential | APRN
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Telephone | 912-223-2310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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