Provider Demographics
NPI:1386466118
Name:CLEARPATH PSYCHIATRY LLC
Entity type:Organization
Organization Name:CLEARPATH PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YEBU
Authorized Official - Middle Name:YAYE
Authorized Official - Last Name:JALLOH CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:CNP, PMHNP-BC
Authorized Official - Phone:770-527-6341
Mailing Address - Street 1:600 WESTRIDGE PKWY STE 714
Mailing Address - Street 2:PMB 1282
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7789
Mailing Address - Country:US
Mailing Address - Phone:770-527-6341
Mailing Address - Fax:
Practice Address - Street 1:600 WESTRIDGE PKWY STE 714
Practice Address - Street 2:PMB 1282
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7789
Practice Address - Country:US
Practice Address - Phone:770-527-6341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty