Basic Information
| Provider Information | |||||||||
| NPI: | 1467874511 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PSYCH CONSULTANTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 427 N BELAIR RD | ||||||||
| Address2: | |||||||||
| City: | EVANS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308093003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064101202 | ||||||||
| FaxNumber: | 6784124160 | ||||||||
| Practice Location | |||||||||
| Address1: | 427 N BELAIR RD | ||||||||
| Address2: | |||||||||
| City: | EVANS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 308093003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064101202 | ||||||||
| FaxNumber: | 6784124160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2014 | ||||||||
| LastUpdateDate: | 06/06/2014 | ||||||||
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| AuthorizedOfficialLastName: | BABATOPE | ||||||||
| AuthorizedOfficialFirstName: | OLASIMBO | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7703151657 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 053089 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.