Healthcare Provider Details

I. General information

NPI: 1912986282
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES OF SOUTH GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 N OAK STREET EXT SUITE C
VALDOSTA GA
31602-1007
US

IV. Provider business mailing address

3120 N OAK STREET EXT STE C
VALDOSTA GA
31602-5910
US

V. Phone/Fax

Practice location:
  • Phone: 229-671-6100
  • Fax:
Mailing address:
  • Phone: 229-671-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE B. STEPHENS
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 229-671-6108