Provider Demographics
NPI:1245036573
Name:GEORGIA PSYCHIATRY SERVICES LLC
Entity type:Organization
Organization Name:GEORGIA PSYCHIATRY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:912-223-2310
Mailing Address - Street 1:429 EAGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548-6495
Mailing Address - Country:US
Mailing Address - Phone:912-223-2310
Mailing Address - Fax:912-250-5813
Practice Address - Street 1:130 N GROSS RD
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6262
Practice Address - Country:US
Practice Address - Phone:912-208-2055
Practice Address - Fax:912-250-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003214783AMedicaid
GA003214783BMedicaid