Organization
AMETHYST PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASMINE WINBUSH PSYD (PRESIDENT)
(470) 223-5921
Entity
Organization
Contact information
Practice address
1774 CENTURY BLVD NE STE B, ATLANTA, GA 30345-3312
(470) 223-5921
Mailing address
4617 IVYGATE CIR SE, ATLANTA, GA 30339-1331
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1073097168
INDIVIDUAL PROVIDER NPI
GA
Enumeration date
02/10/2021
Last updated
02/10/2021
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