PEDIATRIC AND FAMILY BEHAVIORAL HEALTH OF GEORGIA (NPI# 1982216800) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982216800 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC AND FAMILY BEHAVIORAL HEALTH OF GEORGIA |
| Practice Address |
1004 Ulster Court Stockbridge GA 30281 |
| Mailing Address |
110 Walter Way Unit 2635 Stockbridge GA 30281-9526 |
| Practice Telephone | 4049073982 |
| Mailing Telephone | 4049073982 |
| Enumeration Date | 2020-08-21 |
| Last Update Date | 2020-08-21 |
| Authorized Official Name | JOVON TAYLOR (DIRECTOR) |
| Authorized Official Telephone | 4049073982 |
| Authorized Official Credential | MSN, APRN, PMHNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers | ||
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| N | 106H00000X | Marriage & Family Therapist | Behavioral Health & Social Service Providers | ||
| N | 164W00000X | Licensed Practical Nurse | Nursing Service Providers | ||
| N | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians | ||
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 163WP0808X |
Registered Nurse Specialization: Psych/Mental Health |
Nursing Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CAQH | 14596139 | 01 | |
| ANCC CERTIFICATION | 2019050849 | 01 | |
| DEA | MT5938963 | 01 | |
| GA | RN/APRN LICENSE | RN233368 | 01 |
| Street Address |
1004 ULSTER COURT |
| City | STOCKBRIDGE |
| State | GA |
| Zip Code | 30281 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164039095 | Colette Alls | Social Worker | 447 Lakeshore Dr, Stockbridge, GA 30281 | 2020-09-24 |
| 1518577659 | Qunique Taveka Toxey | Behavior Technician | 115 N Park Trail, Suite 123, Stockbridge, GA 30281 | 2020-08-04 |
| 1497377675 | Melanie Harvey | Pharmacist | 4467 North Henry Boulevard, Stockbridge, GA 30281 | 2020-05-11 |
| 1114550571 | Cecile Maria Dunkley Layne | Counselor | 255 Corporte Drive, Stockbridge, GA 30281 | 2020-02-13 |
| 1306407143 | Palliative Care of Georgia. LLC | Home Health | 275 Corporate Center Court Ste C, Stockbridge, GA 30281 | 2019-06-24 |
| 1154883791 | Aaliyah Nura Fardan-alexander | Nurse's Aide | 105 Singletree, Stockbridge, GA 30281 | 2019-04-02 |
| 1306306261 | Prosthetic Care, Inc. | Prosthetic/Orthotic Supplier | 150 County Club Drive, Suite 200, Stockbridge, GA 30281 | 2019-03-25 |
| 1356814172 | Kristina Louissaint | Nurse Practitioner | 650 Country Club Dr, Stockbridge, GA 30281 | 2019-01-03 |
| 1942789284 | Cameren Barnes | Physical Therapist | 5473 N Henry Blvd, Stockbridge, GA 30281 | 2018-08-08 |
| 1548748379 | Jennifer Schafer | Social Worker | 224 Country Club Dr, Stockbridge, GA 30281 | 2018-08-03 |
| Find all providers in zip 30281 | ||||
| Taxonomy Code | 163WP0808X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386838050 | Elizabeth Fedotowsky | Registered Nurse | 25 Main Street, Stockbridge, MA 01262 | 2007-09-05 |
| 1164625570 | Ruth Elisabeth Guttormsen | Registered Nurse | 25 Main St., Stockbridge, MA 01262 | 2007-06-06 |
| 1376754499 | Sandra Herliczek Lebow | Registered Nurse | 25 Main Street, Stockbridge, MA 01262 | 2007-05-24 |
| 1790902682 | Karen R Stuecklen | Registered Nurse | 25 Main Street, Stockbridge, MA 01262 | 2007-04-20 |
| 1487870622 | Elizabeth E Aho | Registered Nurse | 25 Main Street, Stockbridge, MA 01262 | 2007-04-17 |
| 1902020613 | Anne Teresa Zuber | Registered Nurse | 25 Main St, Stockbridge, MA 01262 | 2007-04-12 |
| 1407070774 | Barbara Pamela Turner | Registered Nurse | 25 Main Street, Stockbridge, MA 01262 | 2007-04-11 |
| 1255454864 | Dianne E Heckman | Registered Nurse | 25 Main St, Stockbridge, MA 01262 | 2007-04-09 |
| 1194848515 | Vera May Golden | Registered Nurse | 25 Main St., Stockbridge, MA 01262 | 2007-04-09 |
| 1790807956 | Linda L Vandeusen | Registered Nurse | 25 Main St., Stockbridge, MA 01261-0952 | 2007-04-06 |
| Find all providers in STOCKBRIDGE | ||||
| City | STOCKBRIDGE |
| Zip Code | 30281 |
Please comment or provide details below to improve the information on PEDIATRIC AND FAMILY BEHAVIORAL HEALTH OF GEORGIA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.