Provider Demographics
NPI:1790957348
Name:ALLWELL BEHAVIORAL
Entity Type:Organization
Organization Name:ALLWELL BEHAVIORAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:FAGBAMIYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-333-6711
Mailing Address - Street 1:PO BOX 2144
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31099-2144
Mailing Address - Country:US
Mailing Address - Phone:478-333-6711
Mailing Address - Fax:478-333-6730
Practice Address - Street 1:501 OSIGIAN BLVD
Practice Address - Street 2:STE A
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8928
Practice Address - Country:US
Practice Address - Phone:478-333-6711
Practice Address - Fax:478-333-6730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0560582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA600020201OtherMAGELLAN
GA742988049BMedicaid
GA312991812OtherUNITEDBEHAVIORAL
GA2328379OtherCIGNA
GAI02038Medicare UPIN
GA742988049BMedicaid