Healthcare Provider Details

I. General information

NPI: 1801051297
Provider Name (Legal Business Name): UNISON BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 HARRIS ROAD
WAYCROSS GA
31503
US

IV. Provider business mailing address

1007 MARY STREET
WAYCROSS GA
31503
US

V. Phone/Fax

Practice location:
  • Phone: 912-449-7100
  • Fax: 912-449-7056
Mailing address:
  • Phone: 912-449-7100
  • Fax: 912-449-7056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN BROWN
Title or Position: CEO
Credential:
Phone: 912-449-7100