Provider Demographics
NPI:1073762712
Name:BEACON BEHAVIORAL HEALTHCARE, INC.
Entity Type:Organization
Organization Name:BEACON BEHAVIORAL HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING REP
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SWORDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-269-4620
Mailing Address - Street 1:2209 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-7316
Mailing Address - Country:US
Mailing Address - Phone:229-247-4357
Mailing Address - Fax:
Practice Address - Street 1:2209 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-7316
Practice Address - Country:US
Practice Address - Phone:229-247-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0614142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty