Provider Demographics
NPI:1124255070
Name:GA PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:GA PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNEEL
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:KATRAGADDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-458-0450
Mailing Address - Street 1:2566 SHALLOWFORD RD NE STE 104
Mailing Address - Street 2:PMB 324
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1200
Mailing Address - Country:US
Mailing Address - Phone:404-323-8862
Mailing Address - Fax:404-478-8429
Practice Address - Street 1:2150 PEACHFORD RD STE K
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6539
Practice Address - Country:US
Practice Address - Phone:770-458-0450
Practice Address - Fax:770-458-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA09030920261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)