Provider Demographics
NPI:1992942759
Name:PSYCHIATRY ASSOCIATES OF GEORGIA PC
Entity type:Organization
Organization Name:PSYCHIATRY ASSOCIATES OF GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIJ
Authorized Official - Middle Name:B
Authorized Official - Last Name:GULATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-284-0133
Mailing Address - Street 1:PO BOX 870972
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-0025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 EAGLE SPRING CT
Practice Address - Street 2:SUITE 100A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7274
Practice Address - Country:US
Practice Address - Phone:678-284-0133
Practice Address - Fax:678-284-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA525702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA241352090CMedicaid
GAI60697Medicare UPIN
GA241352090CMedicaid