Provider Demographics
NPI:1457395733
Name:AVENIA BEHAVIORAL MANAGEMENT, INC
Entity Type:Organization
Organization Name:AVENIA BEHAVIORAL MANAGEMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:M,D
Authorized Official - Phone:404-316-4992
Mailing Address - Street 1:2001 MLK JR DR SW STE
Mailing Address - Street 2:SUITES 418/420
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:404-564-4987
Mailing Address - Fax:404-564-4988
Practice Address - Street 1:4500 KARLS GATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2017
Practice Address - Country:US
Practice Address - Phone:770-973-0687
Practice Address - Fax:770-973-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACH7731OtherRR MEDICARE GROUP PIN
GACH7732OtherRR MEDICARE GROUP PIN
GA=========OtherEIN