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General NPI Number Information
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NPI Number | 1538436878
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Entity Type | Organization
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Legal Business Name | MERIDIAN PSYCHIATRIC ASSOCIATES LLC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 551 BOULEVARD SE # D
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City | ATLANTA
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State | GA
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Zip | 30312-3464
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Country | US
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Telephone | 410-409-2348
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Fax |
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Provider Business Mailing Address
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Address Line | 551 BOULEVARD SE # D
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City | ATLANTA
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State | GA
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Zip | 30312-3464
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Country | US
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Telephone | 410-409-2348
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | MS. NIA SIPP
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Credential | M.D.
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Telephone | 410-409-2348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 74316
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License Number State | GA
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