# SOUTHSIDE PSYCHIATRIC CONSULTANTS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Business Owner
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902670490
- **Authorized official:** MR. RALPH OGWOTU NP (BUSINESS OWNER)
- **Authorized official phone:** (404) 734-4445

## Contact information

- **Practice address:** 6572 RIVER PARK DR STE 101G, RIVERDALE, GA 30274-2214
- **Practice address phone:** (404) 734-4445
- **Practice address fax:** (404) 745-0552
- **Mailing address:** 110 W PIER WAY, FAYETTEVILLE, GA 30214-4617
- **Mailing address phone:** (404) 734-4666

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/14/2023
- **Last updated:** 06/17/2025