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Organization
SOUTHSIDE PSYCHIATRIC CONSULTANTS LLC
Active
Organization
SOUTHSIDE PSYCHIATRIC CONSULTANTS LLC
Active
Other names
Business Owner
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RALPH OGWOTU NP (BUSINESS OWNER)
(404) 734-4445
Entity
Organization
Contact information
Practice address
6572 RIVER PARK DR STE 101G, RIVERDALE, GA 30274-2214
(404) 734-4445
(404) 745-0552
Mailing address
110 W PIER WAY, FAYETTEVILLE, GA 30214-4617
(404) 734-4666
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
NULL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/14/2023
Last updated
06/17/2025
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