Provider Demographics
NPI:1497911234
Name:CARNEGIE BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CARNEGIE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-716-6012
Mailing Address - Street 1:175 CARNEGIE PL STE 109
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7903
Mailing Address - Country:US
Mailing Address - Phone:770-716-6012
Mailing Address - Fax:770-716-6013
Practice Address - Street 1:175 CARNEGIE PL STE 109
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7903
Practice Address - Country:US
Practice Address - Phone:770-716-6012
Practice Address - Fax:770-716-6013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002374261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000857095BMedicaid
GAP63030Medicare UPIN
GA000857095BMedicaid