NPI Code Details Logo

NPI 1831893353

NPI 1831893353 : BHG LXVI, LLC : ALBANY, GA

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1831893353
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    BHG LXVI, LLC 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    03/28/2023
-----------------------------------------------------
    Last Update Date     |    04/07/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    2607 LEDO ROAD OBOT ROOM #100
-----------------------------------------------------
    City                 |    ALBANY
-----------------------------------------------------
    State                |    GA
-----------------------------------------------------
    Zip                  |    31707-1211
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    229-903-0022
-----------------------------------------------------
    Fax                  |    229-903-0025
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    5001 SPRING VALLEY ROAD SUITE 600 EAST
-----------------------------------------------------
    City                 |    DALLAS
-----------------------------------------------------
    State                |    TX
-----------------------------------------------------
    Zip                  |    75244-3946
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    214-365-6100
-----------------------------------------------------
    Fax                  |    214-365-6160
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    DIRECTOR
-----------------------------------------------------
    Name                 |     ZACK  RAGSDALE 
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    512-454-5911
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    101YA0400X
-----------------------------------------------------
    Taxonomy Name        |    Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    207QA0401X
-----------------------------------------------------
    Taxonomy Name        |    Addiction Medicine (Family Medicine) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
    Taxonomy Code        |    207RA0401X
-----------------------------------------------------
    Taxonomy Name        |    Addiction Medicine (Internal Medicine) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
    Taxonomy Code        |    2083A0300X
-----------------------------------------------------
    Taxonomy Name        |    Addiction Medicine (Preventive Medicine) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
    Taxonomy Code        |    363L00000X
-----------------------------------------------------
    Taxonomy Name        |    Nurse Practitioner
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
    Taxonomy Code        |    363LP0808X
-----------------------------------------------------
    Taxonomy Name        |    Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
    Taxonomy Code        |    2084A0401X
-----------------------------------------------------
    Taxonomy Name        |    Addiction Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------



                        

Copyright © 2007-2025 Data Labs Health. All rights reserved.