Healthcare Provider Details

I. General information

NPI: 1588861876
Provider Name (Legal Business Name): RAMSAY YOUTH SERVICES OF GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 RIVERSIDE DRIVE
MACON GA
31210-0000
US

IV. Provider business mailing address

3500 RIVERSIDE DRIVE
MACON GA
31210-0000
US

V. Phone/Fax

Practice location:
  • Phone: 478-477-3829
  • Fax: 478-314-1728
Mailing address:
  • Phone: 478-477-3829
  • Fax: 478-314-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number011-657
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number011-615
License Number StateGA

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: SRVP CFO
Credential:
Phone: 800-768-3300