Provider Demographics
NPI:1659074482
Name:MIDDLE GEORGIA MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:MIDDLE GEORGIA MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BAILEY
Authorized Official - Middle Name:COLLINS CORRELL
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-270-3022
Mailing Address - Street 1:2278 MOODY RD STE D
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-1933
Mailing Address - Country:US
Mailing Address - Phone:706-270-3022
Mailing Address - Fax:
Practice Address - Street 1:2278 MOODY RD STE D
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-1933
Practice Address - Country:US
Practice Address - Phone:706-270-3022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health