Healthcare Provider Details

I. General information

NPI: 1841782927
Provider Name (Legal Business Name): ADVANTAGE BEHAVIORAL HEALTH SYSTEMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 06/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MITCHELL BRIDGE RD
ATHENS GA
30606-2043
US

IV. Provider business mailing address

250 NORTH AVE
ATHENS GA
30601-2244
US

V. Phone/Fax

Practice location:
  • Phone: 706-389-6789
  • Fax: 706-389-6768
Mailing address:
  • Phone: 706-389-6789
  • Fax: 706-227-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. OLIVER J BOOKER
Title or Position: CEO
Credential:
Phone: 706-389-6789