Provider Demographics
NPI:1871272765
Name:RESILIENT MINDS PSYCHIATRIC CARE OF MIDDLE GEORGIA LLC
Entity type:Organization
Organization Name:RESILIENT MINDS PSYCHIATRIC CARE OF MIDDLE GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-300-7020
Mailing Address - Street 1:110 KELLWOOD DR STE 220A
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3263
Mailing Address - Country:US
Mailing Address - Phone:478-300-7020
Mailing Address - Fax:478-395-5221
Practice Address - Street 1:110 KELLWOOD DR STE 220A
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3263
Practice Address - Country:US
Practice Address - Phone:478-300-7020
Practice Address - Fax:478-395-5221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty