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Organization
GEORGIA PSYCH SERVICES LLC
Active
Organization
GEORGIA PSYCH SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT SEAN RAE MD (CEO)
(330) 536-3746
Entity
Organization
Contact information
Practice address
4922 BILL GARDNER PKWY # 2, LOCUST GROVE, GA 30248-3647
(330) 536-3746
(330) 267-4250
Mailing address
3593 MEDINA LINE RD 181, MEDINA, OH 44256
(330) 664-9250
(330) 267-4250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/02/2021
Last updated
08/24/2021
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