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General NPI Number Information
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NPI Number | 1578839668
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Entity Type | Organization
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Legal Business Name | ST. MARYS PSYCHIATRY, INC.
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Dates
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Enumeration Date | 03/22/2012
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Last Update Date | 03/24/2012
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Provider Practice Location Address
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Address Line | 4445 HWY 40 SUITE 601
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City | SAINT MARYS
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State | GA
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Zip | 31558-4099
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Country | US
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Telephone | 912-576-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 4445 HWY 40 SUITE 601
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City | SAINT MARYS
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State | GA
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Zip | 31558-4099
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Country | US
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Telephone | 912-576-6800
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIST
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Name | DR. RUXANDRA MARES
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Credential | M.D.
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Telephone | 912-576-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 58799
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License Number State | GA
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