Organization
PSYCH PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MUBBASHIR M KHAN M.D (CEO/ M.D)
(912) 260-1206
Entity
Organization
Contact information
Practice address
410 SHIRLEY AVE, DOUGLAS, GA 31533-2002
(912) 260-1206
(912) 383-7820
Mailing address
410 SHIRLEY AVE, DOUGLAS, GA 31533-2002
(912) 260-1206
(912) 383-7820
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
054327
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003120037D
—
GA
Enumeration date
04/15/2015
Last updated
04/15/2015
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