Provider Demographics
NPI:1326444951
Name:GEORGIA BEHAVIORAL HEALTH PROFESSIONALS
Entity Type:Organization
Organization Name:GEORGIA BEHAVIORAL HEALTH PROFESSIONALS
Other - Org Name:CROSSROADS BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGTACHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-548-2589
Mailing Address - Street 1:2511 HIGHWAY 34 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2309
Mailing Address - Country:US
Mailing Address - Phone:678-423-5500
Mailing Address - Fax:
Practice Address - Street 1:2511 HIGHWAY 34 E
Practice Address - Street 2:SUITE C
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2309
Practice Address - Country:US
Practice Address - Phone:678-423-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty