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General NPI Number Information
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NPI Number | 1497911234
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Entity Type | Organization
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Legal Business Name | CARNEGIE BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 175 CARNEGIE PL STE 109
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7903
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Country | US
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Telephone | 770-716-6012
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Fax | 770-716-6013
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Provider Business Mailing Address
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Address Line | 175 CARNEGIE PL STE 109
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-7903
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Country | US
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Telephone | 770-716-6012
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Fax | 770-716-6013
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JONATHAN D HAUSER
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Credential | PHD
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Telephone | 770-716-6012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | PSY002374
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License Number State | GA
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