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General NPI Number Information
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NPI Number | 1588679203
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Entity Type | Organization
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Legal Business Name | TMC WEST GEORGIA BEHAVIORAL HEALTH INC
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 101 QUARTZ DR SUITE 103
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City | VILLA RICA
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State | GA
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Zip | 30180-3255
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Country | US
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Telephone | 770-456-3722
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Fax | 770-456-3739
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Provider Business Mailing Address
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Address Line | 101 QUARTZ DR SUITE 103
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City | VILLA RICA
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State | GA
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Zip | 30180-3255
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Country | US
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Telephone | 770-456-3722
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Fax | 770-456-3739
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DEBBI MACALUSO-PEARE
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Credential |
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Telephone | 770-838-8554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 035853
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License Number State | GA
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