Provider Demographics
NPI:1710186697
Name:BETHANY CHRISTIAN SERVICES OF GEORGIA
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:770-274-3400
Mailing Address - Street 1:6645 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-1606
Mailing Address - Country:US
Mailing Address - Phone:770-455-7111
Mailing Address - Fax:770-274-3000
Practice Address - Street 1:6645 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-1606
Practice Address - Country:US
Practice Address - Phone:770-455-7111
Practice Address - Fax:770-274-3000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY CHRISTIAN SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP0000040035251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health