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General NPI Number Information
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NPI Number | 1689725756
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC & COUNSELING SERVICES OF COFFEE COUNTY
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 303A SHIRLEY AVE
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City | DOUGLAS
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State | GA
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Zip | 31533-2333
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Country | US
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Telephone | 912-383-8806
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Fax | 912-383-8147
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Provider Business Mailing Address
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Address Line | 303A SHIRLEY AVE
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City | DOUGLAS
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State | GA
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Zip | 31533-2333
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Country | US
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Telephone | 912-383-8806
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Fax | 912-383-8147
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KARUNA DYAPA REDDY
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Credential | MD
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Telephone | 912-383-8806
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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 | 029519
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License Number State | GA
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