Provider Demographics
NPI:1043845373
Name:IVY COLLABORATIVE HEALTHCARE LLC
Entity type:Organization
Organization Name:IVY COLLABORATIVE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:BAYLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-364-3461
Mailing Address - Street 1:2100 CENTRAL AVENUE
Mailing Address - Street 2:STES 6 & 7
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6709
Mailing Address - Country:US
Mailing Address - Phone:706-364-3461
Mailing Address - Fax:706-364-3481
Practice Address - Street 1:2100 CENTRAL AVENUE
Practice Address - Street 2:STES 6 & 7
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6717
Practice Address - Country:US
Practice Address - Phone:706-364-3461
Practice Address - Fax:706-364-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty