Healthcare Provider Details

I. General information

NPI: 1124922455
Provider Name (Legal Business Name): AURELIA BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 US HWY 17 500 PMB 1100
RICHMOND HILL GA
31324
US

IV. Provider business mailing address

3801 US HWY 17 500 PMB 1100
RICHMOND HILL GA
31324
US

V. Phone/Fax

Practice location:
  • Phone: 954-498-3926
  • Fax:
Mailing address:
  • Phone: 954-498-3926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: JADA EUGENE
Title or Position: OWNER
Credential: PMHNP
Phone: 954-498-3926