MEDICARE: RIVERTOWN PSYCHIATRY, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	62002	GA
2	2084P0800X	Psychiatry Physician	62002	GA

General Provider Information

NPI Number	:	1023362852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERTOWN PSYCHIATRY, PC

Provider Business Mailing Address
First Line	:	6003 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6200
Country	:	US
Telephone Number	:	706-223-1933
Fax Number	:	706-223-1934

Provider Business Practice Location Address
First Line	:	6003 VETERANS PKWY
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-6200
Country	:	US
Telephone Number	:	706-223-1933
Fax Number	:	706-223-1934

Authorized Official
Title or Position	:	OWNER
Name	:	KAIZAD P SHROFF
Credential	:	MD
Telephone Number	:	706-223-1933

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	06/16/2023

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