Organization
PEACHSTATE PSYCHIATRIC SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWIGHT A. OWENS M.D. (OWNER)
(404) 575-4785
Entity
Organization
Contact information
Practice address
1720 PEACHTREE ST NW STE 640, ATLANTA, GA 30309-2450
(404) 575-4785
Mailing address
1720 PEACHTREE ST NW STE 640, ATLANTA, GA 30309-2450
(404) 575-4785
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
080408LGB
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000851309A
MEDICAID GBH
—
01
—
102379467
UBH/EVERCARE
—
01
—
158479400
OWCP
—
01
—
162363
VALUE OPTIONS
—
01
—
26BDHBD
WELLCARE MEDICARE
—
01
—
27868800
WELLCRE MEDICAID
—
01
—
278688000
MAGELLAN PERSONAL
—
01
—
52806851
BC/BS GEORGIA
GA
01
—
52806851
BC/BS PLAN LOCATOR
—
01
—
713313717
AMERIGROUP
—
01
—
7698253
AETNA
GA
01
—
80440600
MAGELLAN GROUP
GA
05
—
CLARENCE5
—
GA
Enumeration date
08/13/2009
Last updated
08/13/2009
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