Provider Demographics
NPI:1265661763
Name:PIEDMONT BEHAVIORAL MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PIEDMONT BEHAVIORAL MEDICINE ASSOCIATES, LLC
Other - Org Name:PIEDMONT BEHAVIORAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:PO BOX 402368
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2368
Mailing Address - Country:US
Mailing Address - Phone:803-323-2775
Mailing Address - Fax:803-325-2484
Practice Address - Street 1:200 S HERLONG AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3399
Practice Address - Country:US
Practice Address - Phone:803-323-2775
Practice Address - Fax:803-325-2484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5269Medicaid
SC9325Medicare PIN
DP8552Medicare PIN