Provider Demographics
NPI:1639318785
Name:HAVEN BEHAVIORAL SERVICES OF SOUTH ATLANTA, LLC
Entity Type:Organization
Organization Name:HAVEN BEHAVIORAL SERVICES OF SOUTH ATLANTA, LLC
Other - Org Name:HAVEN BEHAVIORAL SENIOR CARE AT SOUTH FULTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-250-9160
Mailing Address - Street 1:652 W IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3191
Mailing Address - Country:US
Mailing Address - Phone:615-250-9500
Mailing Address - Fax:615-250-9515
Practice Address - Street 1:1170 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3615
Practice Address - Country:US
Practice Address - Phone:404-209-8700
Practice Address - Fax:404-209-8555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAVEN BEHAVIORAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital