SOUTHSIDE PSYCHIATRIC CONSULTANTS LLC NPI 1902670490

NPI Information

  • NPI: 1902670490
  • Provider Name: SOUTHSIDE PSYCHIATRIC CONSULTANTS LLC
  • Classification: Nurse Practitioner - 363LP0808X
  • Specialization: Psychiatric/Mental Health
  • Entity Type: Organization
  • :
  • Address: 6572 RIVER PARK DR STE 101G
    RIVERDALE, GA
    ZIP 30274
  • Phone: (404) 734-4445

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NPI Details

SOUTHSIDE PSYCHIATRIC CONSULTANTS LLC is a psychiatric/mental health nurse practitioner in Riverdale, GA. SOUTHSIDE PSYCHIATRIC CONSULTANTS LLC NPI is 1902670490. The provider is registered as an organization entity type.
The provider .

The provider's business location address is:

6572 RIVER PARK DR STE 101G
RIVERDALE, GA
ZIP 30274-214
Phone: (404) 734-4445
Fax: (404) 745-0552

The provider's authorized official is Ralph Ogwotu .
The authorized official title is Business Owner and has the following contact phone number (404) 734-4445.

The enumeration date for this NPI number is 11/14/2023 and was last updated on 6/17/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1251S00000XCommunity/Behavioral HealthNo
2261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)No
3363LP0808XNurse PractitionerPsychiatric/Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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