Provider Demographics
NPI:1326386780
Name:EASTERN ATLANTA BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:EASTERN ATLANTA BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:NORNIELLA
Authorized Official - Last Name:NORNIELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-705-1687
Mailing Address - Street 1:1592 MARS HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4890
Mailing Address - Country:US
Mailing Address - Phone:706-705-1687
Mailing Address - Fax:706-705-1654
Practice Address - Street 1:1592 MARS HILL RD STE B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4890
Practice Address - Country:US
Practice Address - Phone:706-705-1687
Practice Address - Fax:706-705-1654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-19
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121008882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty