Healthcare Provider Details

I. General information

NPI: 1538214374
Provider Name (Legal Business Name): OGEECHEE BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 W 4TH ST
WAYNESBORO GA
30830-1559
US

IV. Provider business mailing address

223 N. ANDERSON DRIVE P O BOX 1259
SWAINSBORO GA
30401
US

V. Phone/Fax

Practice location:
  • Phone: 706-437-6863
  • Fax: 706-437-6860
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMY A TRIBBLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 478-289-2522