Provider Demographics
NPI:1710573936
Name:EAST CONYERS BEHAVIORAL HEALTH CLINIC
Entity Type:Organization
Organization Name:EAST CONYERS BEHAVIORAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:YALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-679-5453
Mailing Address - Street 1:1277 WELLBROOK CIR NE STE A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3973
Mailing Address - Country:US
Mailing Address - Phone:770-679-5453
Mailing Address - Fax:770-679-5457
Practice Address - Street 1:1277 WELLBROOK CIR NE STE A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3973
Practice Address - Country:US
Practice Address - Phone:770-679-5453
Practice Address - Fax:770-679-5457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-13
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty