Provider Demographics
NPI:1194861443
Name:UNISON BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:UNISON BEHAVIORAL HEALTH
Other - Org Name:SATILLA COMMUNITY SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-449-7100
Mailing Address - Street 1:1007 MARY STREET
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503
Mailing Address - Country:US
Mailing Address - Phone:912-449-7100
Mailing Address - Fax:912-449-7056
Practice Address - Street 1:1005 SHIRLEY AVENUE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533
Practice Address - Country:US
Practice Address - Phone:912-389-4188
Practice Address - Fax:912-449-7056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3993Medicare PIN