Organization
WEST GEORGIA PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TINA MARIE CAUDILL PSY.D. (PSYCHOLOGIST)
(678) 232-9078
Entity
Organization
Contact information
Practice address
6264 HOSPITAL WAY, DOUGLASVILLE, GA 30134-1944
(678) 232-9078
(866) 489-2642
Mailing address
PO BOX 1916, DOUGLASVILLE, GA 30133-1916
(678) 232-9078
(866) 489-2642
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
002899
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10071390
AMERIGROUP
GA
05
—
112025855C
—
GA
05
—
112025855D
—
GA
05
—
112025855E
—
GA
05
—
112025855F
—
GA
Enumeration date
02/08/2007
Last updated
04/24/2012
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