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General NPI Number Information
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NPI Number | 1033921390
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Entity Type | Organization
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Legal Business Name | SOLID GROUND BEHAVIORAL HEALTH PC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 24 CHECHERO ST STE 2
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City | CLAYTON
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State | GA
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Zip | 30525-6181
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Country | US
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Telephone | 706-963-0654
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Fax |
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Provider Business Mailing Address
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Address Line | 12244 AUGUSTA RD UNIT 108
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City | LAVONIA
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State | GA
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Zip | 30553-1210
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Country | US
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Telephone | 706-983-9411
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MARY KELLER
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Credential | PMHNP-BC
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Telephone | 706-963-0654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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