MEDICARE: PSYCHIATRIC MEDICAL SPECIALIST OF ATLANTA

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	174400000X	Specialist	014956	GA

General Provider Information

NPI Number	:	1871790410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRIC MEDICAL SPECIALIST OF ATLANTA

Provider Business Mailing Address
First Line	:	4015 S COBB DR SE STE 10
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:	770-874-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 S COBB DR SE STE 10
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:	770-874-6100
Fax Number	:

Authorized Official
Title or Position	:	PESIDENT
Name	:	SEYMOUR O SOLODAR
Credential	:	MD
Telephone Number	:	770-874-6100

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	08/22/2020

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