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General NPI Number Information
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NPI Number | 1396389185
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Entity Type | Organization
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Legal Business Name | KEYSTONE PSYCHIATRIC CARE LLC
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Dates
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Enumeration Date | 11/05/2019
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 11030 JONES BRIDGE RD STE 301
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City | JOHNS CREEK
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State | GA
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Zip | 30022-4560
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Country | US
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Telephone | 561-568-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 11030 JONES BRIDGE RD STE 301
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City | JOHNS CREEK
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State | GA
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Zip | 30022-4560
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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 | MANAGER
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Name | ROOPA CRAWFORD
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Credential |
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Telephone | 561-568-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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