Healthcare Provider Details

I. General information

NPI: 1114855103
Provider Name (Legal Business Name): RIVER EDGE BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BOLAND CIR
SPARTA GA
31087-2007
US

IV. Provider business mailing address

1241 ORCHARD HILL RD
MILLEDGEVILLE GA
31061-2549
US

V. Phone/Fax

Practice location:
  • Phone: 478-803-7700
  • Fax:
Mailing address:
  • Phone: 478-803-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA OAKES
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 478-803-7809