Provider Demographics
NPI:1558195305
Name:RADIANT LIGHT PSYCHIATRY
Entity type:Organization
Organization Name:RADIANT LIGHT PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUSHANAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUD-ALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:404-692-1801
Mailing Address - Street 1:705 CARNABY CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-2941
Mailing Address - Country:US
Mailing Address - Phone:404-692-1801
Mailing Address - Fax:
Practice Address - Street 1:705 CARNABY CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-2941
Practice Address - Country:US
Practice Address - Phone:404-692-1801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty