Provider Demographics
NPI:1083177430
Name:GEORGIA REGIONAL BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:GEORGIA REGIONAL BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ BCBA
Authorized Official - Prefix:
Authorized Official - First Name:CHAZITY
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:808-476-4536
Mailing Address - Street 1:3484 LACHLAN DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6001
Mailing Address - Country:US
Mailing Address - Phone:808-476-4536
Mailing Address - Fax:
Practice Address - Street 1:2037 WEEMS RD APT 8105
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5266
Practice Address - Country:US
Practice Address - Phone:808-476-4536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty