Healthcare Provider Details

I. General information

NPI: 1073471876
Provider Name (Legal Business Name): CATOOSA BEHAVIOR HEALTH AND WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RBC DR
RINGGOLD GA
30736-2787
US

IV. Provider business mailing address

102 RBC DR
RINGGOLD GA
30736-2787
US

V. Phone/Fax

Practice location:
  • Phone: 404-937-0561
  • Fax: 404-937-0561
Mailing address:
  • Phone: 404-937-0561
  • Fax: 404-937-0561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LUD HARRIS
Title or Position: CLINICAL DIRECTOR
Credential: PMHNP
Phone: 404-937-0561