Provider Demographics
NPI:1912447897
Name:BETHANY CHRISTIAN SERVICES
Entity Type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NONYEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-455-7111
Mailing Address - Street 1:188 BEN BURTON CIR
Mailing Address - Street 2:UNIT 100
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-6802
Mailing Address - Country:US
Mailing Address - Phone:706-621-3317
Mailing Address - Fax:770-274-3000
Practice Address - Street 1:188 BEN BURTON CIR
Practice Address - Street 2:UNIT 100
Practice Address - City:BOGART
Practice Address - State:GA
Practice Address - Zip Code:30622-6802
Practice Address - Country:US
Practice Address - Phone:706-621-3317
Practice Address - Fax:770-274-3000
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHANY CHRISTIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty