Healthcare Provider Details

I. General information

NPI: 1851237440
Provider Name (Legal Business Name): PBS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTHSIDE XING STE A
MACON GA
31210-2377
US

IV. Provider business mailing address

500 NORTHSIDE XING STE A
MACON GA
31210-2377
US

V. Phone/Fax

Practice location:
  • Phone: 478-216-2876
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: ASHANTII WILSON
Title or Position: ASSISTANT
Credential:
Phone: 478-421-4938