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General NPI Number Information
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NPI Number | 1922230648
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Entity Type | Organization
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Legal Business Name | PEACHSTATE PSYCHIATRIC SERVICES, INC.
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 1720 PEACHTREE ST NW STE 640
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City | ATLANTA
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State | GA
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Zip | 30309-2450
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Country | US
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Telephone | 404-575-4785
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 PEACHTREE ST NW STE 640
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City | ATLANTA
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State | GA
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Zip | 30309-2450
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Country | US
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Telephone | 404-575-4785
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DWIGHT A. OWENS
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Credential | M.D.
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Telephone | 404-575-4785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 080408LGB
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License Number State | GA
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