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General NPI Number Information
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NPI Number | 1477265718
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Entity Type | Organization
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Legal Business Name | GEODE HEALTH OF GEORGIA LLC
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 227 SCENIC HWY STE A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5649
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Country | US
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Telephone | 630-912-4241
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 W 22ND ST STE 406
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City | OAK BROOK
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State | IL
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Zip | 60523-2169
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Country | US
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Telephone | 888-902-1704
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Fax | 302-907-3568
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | BRANDY L MARRINER
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Credential |
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Telephone | 630-912-4241
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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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