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NPI Code Detail

MEDICARE: BHG LXVI, LLC

MEDICARE: BHG LXVI, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2207LA0401XAddiction Medicine (Anesthesiology) Physician
3207QA0401XAddiction Medicine (Family Medicine) Physician
4207RA0401XAddiction Medicine (Internal Medicine) Physician
52083A0300XAddiction Medicine (Preventive Medicine) Physician
6363L00000XNurse Practitioner
7363LP0808XPsychiatric/Mental Health Nurse Practitioner
82084A0401XAddiction Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number : 1003510520
Entity Type Code : Organization
Provider Name (Legal Business Name) : BHG LXVI, LLC
Provider Business Mailing Address
First Line : 5001 SPRING VALLEY ROAD
Second Line : SUITE 600 EAST
City : DALLAS
State : TX
Zip : 75244-3946
Country : US
Telephone Number : 214-365-6100
Fax Number : 214-365-6150
Provider Business Practice Location Address
First Line : 794 MCDONOUGH ROAD
Second Line : SUITE #104, OBOT ROOM #100
City : JACKSON
State : GA
Zip : 30233-1572
Country : US
Telephone Number : 770-775-9044
Fax Number : 770-775-9075
Authorized Official
Title or Position : DIRECTOR
Name : ZACK RAGSDALE
Credential :
Telephone Number : 512-454-5911
Provider Enumeration Date : 03/28/2023
Last Update Date : 04/07/2025

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