MEDICARE: GEORGE B. WEST MENTAL HEALTH FOUNDATION

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1639268022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE B. WEST MENTAL HEALTH FOUNDATION

Provider Business Mailing Address
First Line	:	1903 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-4119
Country	:	US
Telephone Number	:	404-315-8333
Fax Number	:	404-315-9838

Provider Business Practice Location Address
First Line	:	1903 N DRUID HILLS RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-4119
Country	:	US
Telephone Number	:	404-315-8333
Fax Number	:	404-315-9838

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MR. RICKY PADGETT
Credential	:
Telephone Number	:	404-315-8333

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/22/2020

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