Provider Demographics
NPI:1023362852
Name:RIVERTOWN PSYCHIATRY, PC
Entity type:Organization
Organization Name:RIVERTOWN PSYCHIATRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAIZAD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-223-1933
Mailing Address - Street 1:6003 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-6200
Mailing Address - Country:US
Mailing Address - Phone:706-223-1933
Mailing Address - Fax:706-223-1934
Practice Address - Street 1:6003 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6200
Practice Address - Country:US
Practice Address - Phone:706-223-1933
Practice Address - Fax:706-223-1934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA620022084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty