Healthcare Provider Details

I. General information

NPI: 1164358289
Provider Name (Legal Business Name): IMAGO DEI THERAPEUTIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 HATCHER POINT RD
WAYCROSS GA
31503-7959
US

IV. Provider business mailing address

363 JOYCE RD
WAYCROSS GA
31503-2901
US

V. Phone/Fax

Practice location:
  • Phone: 912-286-3737
  • Fax:
Mailing address:
  • Phone: 912-286-3737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MELISSA A FOY
Title or Position: OWNER
Credential:
Phone: 912-286-3737