Healthcare Provider Details

I. General information

NPI: 1740320290
Provider Name (Legal Business Name): BEHAVIORAL HEALTH SERVICES OF SOUTH GEORGIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
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: 229-671-6140
  • Fax: 229-333-5263
Mailing address:
  • Phone: 229-671-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/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