MEDICARE: MK PSYCHIATRIC SERVICES LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710822648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MK PSYCHIATRIC SERVICES LLC

Provider Business Mailing Address
First Line	:	1230 W PEACHTREE ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-4965
Country	:	US
Telephone Number	:	404-640-5469
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 PEACHTREE RD NE STE 6
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1148
Country	:	US
Telephone Number	:	404-640-5469
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALISTS
Name	:	KIMBERLY DAVIS
Credential	:
Telephone Number	:	912-373-4385

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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