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General NPI Number Information
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NPI Number | 1679458566
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Entity Type | Organization
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Legal Business Name | TIDE AND BRANCH PSYCHIATRY LLC
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 04/14/2026
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Provider Practice Location Address
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Address Line | 37 W FAIRMONT AVE STE 317
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City | SAVANNAH
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State | GA
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Zip | 31406-3458
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Country | US
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Telephone | 912-216-2499
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Fax | 866-771-6261
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Provider Business Mailing Address
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Address Line | 37 W FAIRMONT AVE STE 317
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City | SAVANNAH
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State | GA
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Zip | 31406-3458
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Country | US
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Telephone | 912-216-2499
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Fax | 866-771-6261
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Authorized Official
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Title or Position | CO-OWNER
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Name | CALYSTA MEDLEY TILLEY
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Credential |
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Telephone | 912-216-2499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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