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General NPI Number Information
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NPI Number | 1316865462
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Entity Type | Organization
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Legal Business Name | RAVEH20 PSYCHIATRIC & MEDICAL SPECIALIST INC.
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 1680 MULKEY RD STE 200
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City | AUSTELL
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State | GA
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Zip | 30106-1364
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Country | US
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Telephone | 678-744-2318
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Fax | 770-819-6826
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Provider Business Mailing Address
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Address Line | 1680 MULKEY RD STE 200
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City | AUSTELL
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State | GA
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Zip | 30106-1364
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Country | US
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Telephone | 678-744-2318
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Fax | 770-819-6826
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Authorized Official
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Title or Position | CEO
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Name | SHELBY DAVIS
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Credential |
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Telephone | 678-744-2318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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