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General NPI Number Information
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NPI Number | 1992942759
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Entity Type | Organization
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Legal Business Name | PSYCHIATRY ASSOCIATES OF GEORGIA PC
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 01/15/2009
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Provider Practice Location Address
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Address Line | 130 EAGLE SPRING CT SUITE 100A
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7274
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Country | US
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Telephone | 678-284-0133
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Fax | 678-284-6393
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Provider Business Mailing Address
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Address Line | PO BOX 870972
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-0025
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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 | MD/VICE PRESIDENT
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Name | BRIJ B GULATI
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Credential |
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Telephone | 678-284-0133
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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 | 52570
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License Number State | GA
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