| Pathways Center For Behavioral And Developmental Growth | |
|
101 Commerce Plaza Suite 3 Barnesville GA 30204-1680 | |
| (770) 358-5269 | |
| (770) 872-3730 |
| Full Name | Pathways Center For Behavioral And Developmental Growth |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 101 Commerce Plaza, Barnesville, Georgia |
| Authorized Official Name and Position | Jade Russell Benefield (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7068454045 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathways Center For Behavioral And Developmental Growth 122 Gordon Commercial Drive Suite C Lagrange GA 30240-5740 Ph: (706) 845-4045 | Pathways Center For Behavioral And Developmental Growth 101 Commerce Plaza Suite 3 Barnesville GA 30204-1680 Ph: (770) 358-5269 |
| NPI Number | 1124183082 |
|---|---|
| Provider Enumeration Date | 12/22/2006 |
| Last Update Date | 02/26/2013 |
| Medicare PECOS PAC ID | 5193712073 |
|---|---|
| Medicare Enrollment ID | O20040430000883 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124183082 | NPI | - | NPPES |
| 000599332AJ | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Maria L Bejacmar-didier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447378971 PECOS PAC ID: 5294831525 Enrollment ID: I20070503000323 |
| Provider Name | Jithender Reddy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114955457 PECOS PAC ID: 4284605593 Enrollment ID: I20101103000997 |
| Provider Name | Roseline A Makinde |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902108491 PECOS PAC ID: 5193904506 Enrollment ID: I20110131000831 |
| Provider Name | Amber N Tidwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073862751 PECOS PAC ID: 6507018389 Enrollment ID: I20121129000456 |
| Provider Name | Mary Lou Devaul-eshleman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104972025 PECOS PAC ID: 9234210964 Enrollment ID: I20130723000088 |
| Provider Name | Allen Lavender |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124339478 PECOS PAC ID: 7810123288 Enrollment ID: I20141202000766 |
| Provider Name | Lauren E Hornsby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972932036 PECOS PAC ID: 9739405747 Enrollment ID: I20150311000695 |
| Provider Name | Linda Joy Knight- Nelson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952425183 PECOS PAC ID: 0042386716 Enrollment ID: I20160829000736 |
| Provider Name | Rugiatu Bahr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861958472 PECOS PAC ID: 1951633262 Enrollment ID: I20191105002287 |
| Provider Name | Sabrina Powell-cobb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417513557 PECOS PAC ID: 9537593645 Enrollment ID: I20191226000889 |
| Provider Name | Jennifer N Mullins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417528373 PECOS PAC ID: 1850784489 Enrollment ID: I20220203000906 |
| Provider Name | Ashraf M Attalla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417067489 PECOS PAC ID: 9537053087 Enrollment ID: I20220221001096 |
| Provider Name | Candace J Nolton |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699272682 PECOS PAC ID: 1456721265 Enrollment ID: I20230111002101 |
| Provider Name | Grant A Defrancisco |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1962909242 PECOS PAC ID: 0345599890 Enrollment ID: I20230927000119 |
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