Healthcare Provider Details

I. General information

NPI: 1649201625
Provider Name (Legal Business Name): INTEGRATED BEHAVIORAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 CORNELL AVENUE
SAVANNAH GA
31406
US

IV. Provider business mailing address

1121 CORNELL AVENUE
SAVANNAH GA
31406
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-4987
  • Fax: 912-353-7257
Mailing address:
  • Phone: 912-355-4987
  • Fax: 912-353-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number002990
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22536
License Number StateGA

VIII. Authorized Official

Name: MANOJ K DASS
Title or Position: PRESIDENT
Credential: MD
Phone: 912-355-4987