Provider Demographics
NPI:1679464143
Name:CITY PSYCHIATRY
Entity type:Organization
Organization Name:CITY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA-C / MINORITY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KASARA
Authorized Official - Middle Name:
Authorized Official - Last Name:AL HELOU
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:404-964-5415
Mailing Address - Street 1:2219 CARSON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-3106
Mailing Address - Country:US
Mailing Address - Phone:404-964-5415
Mailing Address - Fax:854-228-6420
Practice Address - Street 1:2219 CARSON VALLEY DR
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3106
Practice Address - Country:US
Practice Address - Phone:404-964-5415
Practice Address - Fax:854-228-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center