| Southern Behavioral Healthcare,p.c | |
|
110 Braxton Ct Fayetteville GA 30214-1968 | |
| (678) 610-7100 | |
| (678) 610-7111 |
| Full Name | Southern Behavioral Healthcare,p.c |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 110 Braxton Ct, Fayetteville, Georgia |
| Authorized Official Name and Position | Salewa Taiwo (OFFICE MANAGER) |
| Authorized Official Contact | 6786107100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Behavioral Healthcare,p.c 110 Braxton Ct Fayetteville GA 30214-1968 Ph: (678) 610-7100 | Southern Behavioral Healthcare,p.c 110 Braxton Ct Fayetteville GA 30214-1968 Ph: (678) 610-7100 |
| NPI Number | 1598732869 |
|---|---|
| Provider Enumeration Date | 03/04/2006 |
| Last Update Date | 09/14/2022 |
| Certification Date | 09/14/2022 |
| Medicare PECOS PAC ID | 8628194057 |
|---|---|
| Medicare Enrollment ID | O20100923000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598732869 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 64622 (Georgia) | Secondary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 051606 (Georgia) | Primary |
| Provider Name | Olufemi A Taiwo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1225005598 PECOS PAC ID: 2961305495 Enrollment ID: I20040130000742 |
| Provider Name | Karen D Amos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851830533 PECOS PAC ID: 1153686886 Enrollment ID: I20180530003110 |
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