Provider Demographics
NPI:1538436878
Name:MERIDIAN PSYCHIATRIC ASSOCIATES LLC
Entity type:Organization
Organization Name:MERIDIAN PSYCHIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-409-2348
Mailing Address - Street 1:551 BOULEVARD SE # D
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3464
Mailing Address - Country:US
Mailing Address - Phone:410-409-2348
Mailing Address - Fax:
Practice Address - Street 1:551 BOULEVARD SE # D
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-3464
Practice Address - Country:US
Practice Address - Phone:410-409-2348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74316103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty