Provider Demographics
NPI:1255486692
Name:FAMILY BEHAVIORAL CENTER P.C.
Entity type:Organization
Organization Name:FAMILY BEHAVIORAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING PERSON
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-952-2048
Mailing Address - Street 1:4480H S COBB DR SE STE 228
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6958
Mailing Address - Country:US
Mailing Address - Phone:770-432-2159
Mailing Address - Fax:770-432-2506
Practice Address - Street 1:4015 S COBB DR SE STE 101
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6315
Practice Address - Country:US
Practice Address - Phone:770-432-2159
Practice Address - Fax:770-432-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0476272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00889864CMedicaid
GA00889864DMedicaid
GA00889864CMedicaid