# GEORGIA PSYCH SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245801075
- **Authorized official:** ROBERT SEAN RAE MD (CEO)
- **Authorized official phone:** (330) 536-3746

## Contact information

- **Practice address:** 4922 BILL GARDNER PKWY \# 2, LOCUST GROVE, GA 30248-3647
- **Practice address phone:** (330) 536-3746
- **Practice address fax:** (330) 267-4250
- **Mailing address:** 3593 MEDINA LINE RD 181, MEDINA, OH 44256
- **Mailing address phone:** (330) 664-9250
- **Mailing address fax:** (330) 267-4250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/02/2021
- **Last updated:** 08/24/2021