Provider Demographics
NPI:1578397287
Name:BRIGHT IMPACT NOW PSYCHIATRY LLC
Entity type:Organization
Organization Name:BRIGHT IMPACT NOW PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RETTA
Authorized Official - Middle Name:SUGARPEA
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:678-852-3203
Mailing Address - Street 1:2274 LEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-7034
Mailing Address - Country:US
Mailing Address - Phone:678-852-3203
Mailing Address - Fax:
Practice Address - Street 1:619 NEWNAN STREET
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3428
Practice Address - Country:US
Practice Address - Phone:678-852-3203
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty