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General NPI Number Information
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NPI Number | 1982238713
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Entity Type | Organization
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Legal Business Name | PSYCHNP, LLC
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Dates
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Enumeration Date | 03/02/2020
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 109 EASTWICK CT
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City | MACON
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State | GA
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Zip | 31210-1094
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Country | US
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Telephone | 478-283-3087
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Fax |
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Provider Business Mailing Address
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Address Line | 104 BORDERS WAY STE 600
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8967
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | BRIANA HALL
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Credential |
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Telephone | 478-456-6340
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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 |
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License Number State |
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