Provider Demographics
NPI:1114196912
Name:AUSBORN BEHAVIORAL CARE, P.C.
Entity Type:Organization
Organization Name:AUSBORN BEHAVIORAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:AUSBORN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:770-938-4616
Mailing Address - Street 1:1456 MCLENDON DR STE B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1848
Mailing Address - Country:US
Mailing Address - Phone:770-938-4616
Mailing Address - Fax:770-938-4615
Practice Address - Street 1:1456 MCLENDON DR STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1848
Practice Address - Country:US
Practice Address - Phone:770-938-4616
Practice Address - Fax:770-938-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty