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General NPI Number Information
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NPI Number | 1366254005
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Entity Type | Organization
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Legal Business Name | JEFFERSON PSYCHIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 01/21/2025
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 44 PROFESSIONAL DR
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City | JEFFERSON
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State | GA
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Zip | 30549-6333
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Country | US
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Telephone | 706-395-8351
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Fax |
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Provider Business Mailing Address
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Address Line | 154 WASHINGTON ST
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City | JEFFERSON
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State | GA
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Zip | 30549-1003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | BEN HARRISON
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Credential |
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Telephone | 678-897-9717
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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 |
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License Number State |
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