Provider Demographics
NPI:1447558028
Name:PREMIER BEHAVIORAL HEALTH SERVICES OF GEORGIA
Entity Type:Organization
Organization Name:PREMIER BEHAVIORAL HEALTH SERVICES OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SANTHOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-733-2007
Mailing Address - Street 1:775 HOUSTON MILL RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4224
Mailing Address - Country:US
Mailing Address - Phone:678-995-5690
Mailing Address - Fax:404-393-8939
Practice Address - Street 1:775 HOUSTON MILL RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4224
Practice Address - Country:US
Practice Address - Phone:678-995-5690
Practice Address - Fax:404-393-8939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health