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General NPI Number Information
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NPI Number | 1982216800
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Entity Type | Organization
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Legal Business Name | PEDIATRIC AND FAMILY BEHAVIORAL HEALTH OF GEORGIA
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 1004 ULSTER COURT
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 404-907-3982
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Fax |
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Provider Business Mailing Address
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Address Line | 110 WALTER WAY UNIT 2635
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-9526
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Country | US
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Telephone | 404-907-3982
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JOVON TAYLOR
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Credential | MSN, APRN, PMHNP-BC
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Telephone | 404-907-3982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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