Provider Demographics
NPI:1215074786
Name:PADILLA, SARAI (PSYD)
Entity type:Individual
Prefix:DR
First Name:SARAI
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 EAGLES WALK STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDLIN TREATMENT CENTER
Practice Address - Street 2:110 EAGLES WALK, STE. 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7204
Practice Address - Country:US
Practice Address - Phone:770-507-6044
Practice Address - Fax:770-507-5284
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003101103TC0700X, 103TC2200X
NY012193103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA457428408CMedicaid
GA01071167OtherAMERIGROUP
GA457428408BOtherCENPATICO
GA457428408BMedicaid
GA457428408COtherCENPATICO
GA600411039OtherMAGELLAN
GA457428408AOtherCENPATICO
GA457428408AMedicaid