MEDICARE: FAMILY BEHAVIORAL CENTER P.C.

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	2084P0800X	Psychiatry Physician	047627	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255486692
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY BEHAVIORAL CENTER P.C.

Provider Business Mailing Address
First Line	:	4480H S COBB DR SE STE 228
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6958
Country	:	US
Telephone Number	:	770-432-2159
Fax Number	:	770-432-2506

Provider Business Practice Location Address
First Line	:	4015 S COBB DR SE STE 101
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-6315
Country	:	US
Telephone Number	:	770-432-2159
Fax Number	:	770-432-2506

Authorized Official
Title or Position	:	BILLING PERSON
Name	:	MRS. HELEN CHANG
Credential	:
Telephone Number	:	770-952-2048

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/08/2013

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