MEDICARE: SOLID GROUND BEHAVIORAL HEALTH PC

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
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1033921390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLID GROUND BEHAVIORAL HEALTH PC

Provider Business Mailing Address
First Line	:	12244 AUGUSTA RD UNIT 108
Second Line	:
City	:	LAVONIA
State	:	GA
Zip	:	30553-1210
Country	:	US
Telephone Number	:	706-983-9411
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 CHECHERO ST STE 2
Second Line	:
City	:	CLAYTON
State	:	GA
Zip	:	30525-6181
Country	:	US
Telephone Number	:	706-963-0654
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	MARY KELLER
Credential	:	PMHNP-BC
Telephone Number	:	706-963-0654

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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