Provider Demographics
NPI:1972666204
Name:PHOENIX BEHAVIORAL HEALTH SERVICES OF GEORGIA, LLC
Entity type:Organization
Organization Name:PHOENIX BEHAVIORAL HEALTH SERVICES OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-478-3417
Mailing Address - Street 1:8712 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4905
Mailing Address - Country:US
Mailing Address - Phone:770-478-3417
Mailing Address - Fax:770-478-3419
Practice Address - Street 1:8712 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4905
Practice Address - Country:US
Practice Address - Phone:770-478-3417
Practice Address - Fax:770-478-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0212251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health