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General NPI Number Information
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NPI Number | 1982935052
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Entity Type | Organization
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Legal Business Name | VILLA RICA BEHAVIORAL HEALTH PC
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Dates
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Enumeration Date | 01/28/2010
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 514 W BANKHEAD HWY SUITE 400
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City | VILLA RICA
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State | GA
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Zip | 30180-1736
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Country | US
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Telephone | 770-456-2788
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Fax | 770-456-2789
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Provider Business Mailing Address
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Address Line | 514 W BANKHEAD HWY SUITE 400
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City | VILLA RICA
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State | GA
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Zip | 30180-1736
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Country | US
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Telephone | 770-456-2788
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Fax | 770-456-2789
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | GEORGE W. BAILEY
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Credential | M.D.
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Telephone | 770-456-2788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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