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NPI Code Detail

MEDICARE: VITALIS BEHAVIORAL HEALTH

MEDICARE: VITALIS BEHAVIORAL HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1285271528
Entity Type Code : Organization
Provider Name (Legal Business Name) : VITALIS BEHAVIORAL HEALTH
Provider Business Mailing Address
First Line : 1638 BATTLEFIELD PKWY
Second Line :
City : FORT OGLETHORPE
State : GA
Zip : 30742-4016
Country : US
Telephone Number : 706-841-0500
Fax Number : 706-841-0502
Provider Business Practice Location Address
First Line : 1638 BATTLEFIELD PKWY
Second Line :
City : FORT OGLETHORPE
State : GA
Zip : 30742-4016
Country : US
Telephone Number : 706-841-0500
Fax Number : 706-841-0502
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : DENISE GOODWIN
Credential :
Telephone Number : 706-841-0500
Provider Enumeration Date : 12/05/2019
Last Update Date : 07/31/2025

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Directions to “VITALIS BEHAVIORAL HEALTH ” Practice Location

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