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General NPI Number Information
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NPI Number | 1063378396
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Entity Type | Organization
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Legal Business Name | EAGLE BEHAVIORAL SERVICES INC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 5929 LONDON TRCE
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-4500
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Country | US
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Telephone | 470-846-8160
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Fax |
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Provider Business Mailing Address
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Address Line | 5929 LONDON TRCE
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-4500
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Country | US
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Telephone | 470-846-8160
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GARY DOUGLAS STOUT
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Credential |
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Telephone | 470-846-8160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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