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General NPI Number Information
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NPI Number | 1124254941
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES
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Dates
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Enumeration Date | 06/08/2009
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 3073 PANTHERSVILLE RD
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City | DECATUR
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State | GA
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Zip | 30034-3828
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Country | US
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Telephone | 404-212-5454
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Fax | 404-243-2159
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Provider Business Mailing Address
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Address Line | PO BOX 370407
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City | DECATUR
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State | GA
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Zip | 30037-0407
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Country | US
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Telephone | 404-212-5454
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Fax | 404-243-2159
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. EMILE RISBY
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Credential | M.D.
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Telephone | 404-243-2114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 044-232
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License Number State | GA
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