Provider Demographics
NPI:1316369341
Name:BIOLOGIC BEHAVIORAL LLC
Entity Type:Organization
Organization Name:BIOLOGIC BEHAVIORAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-395-5025
Mailing Address - Street 1:2107 N DECATUR RD
Mailing Address - Street 2:SUITE 351
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5305
Mailing Address - Country:US
Mailing Address - Phone:404-395-5025
Mailing Address - Fax:404-370-1324
Practice Address - Street 1:2107 N DECATUR RD
Practice Address - Street 2:SUITE 351
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5305
Practice Address - Country:US
Practice Address - Phone:404-395-5025
Practice Address - Fax:404-370-1324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA581452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty