=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508679697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGIA PSYCHIATRY & SLEEP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2025
-----------------------------------------------------
Last Update Date | 01/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 BALTIMORE PL NW STE 200
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30308-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-737-1606
-----------------------------------------------------
Fax | 833-973-4256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1314 CONCORD RD SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-4361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-438-1799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OFFICE MANAGER
-----------------------------------------------------
Name | HAPPY SHROFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-833-6885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------