Healthcare Provider Details

I. General information

NPI: 1750151767
Provider Name (Legal Business Name): OVERFLOWING HEALTH BEHAVIORAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

461 3RD ST STE 13
MACON GA
31201-3358
US

IV. Provider business mailing address

461 3RD ST STE 13
MACON GA
31201-3358
US

V. Phone/Fax

Practice location:
  • Phone: 478-227-4754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RIUYINOSA ELEMA
Title or Position: OFFICER
Credential:
Phone: 478-227-4754