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General NPI Number Information
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NPI Number | 1811048481
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Entity Type | Organization
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Legal Business Name | PSYCHIATRY ASSCOCIATES OF SOUTH ATLANTA, PC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 250 ARROWHEAD BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-1106
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Country | US
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Telephone | 770-603-8838
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Fax | 770-603-3063
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Provider Business Mailing Address
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Address Line | 250 ARROWHEAD BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-1106
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Country | US
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Telephone | 770-603-8838
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Fax | 770-603-3063
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Authorized Official
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Title or Position | PROVIDER
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Name | NARENDRA NAGAREDDY
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Credential | MD
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Telephone | 770-603-8838
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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 | 046703
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License Number State | GA
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