Georgia Psych Services LLC
Nurse Practitioner, Psych/Mental Health in Locust Grove, GA. Organization (NPI-2).
Details
- NPI
- 1245801075
- Entity type
- Organization (NPI-2)
- Legal business name
- Georgia Psych Services LLC
- Organization subpart
- No
- Enumeration date
- Jul 2, 2021
- Certification date
- Aug 24, 2021
- Last updated
- Aug 24, 2021
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | – | – | Yes |
| 363L00000X | Nurse Practitioner | – | – |
Practice location
4922 Bill Gardner Pkwy # 2Locust Grove, GA 30248-3647
Phone 330-536-3746 · Fax 330-267-4250
Mailing address
3593 Medina Line Rd 181Medina, OH 44256
Phone 330-664-9250 · Fax 330-267-4250
Authorized official
Robert Sean Rae
Ceo
3305363746
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
Other Psychiatric/Mental Health Nurse Practitioner providers in Locust Grove, GA
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- Jennifer Nicole Jenkins, PMHNPNPI 1972308575
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- Angelica Yvette WilliamsNPI 1093674814
All 5 Psychiatric/Mental Health Nurse Practitioner providers in Locust Grove · All 328 providers in Locust Grove
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