MEDICARE: DUNWOODY BEHAVIORAL HEALTH CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
4	323P00000X	Psychiatric Residential Treatment Facility

General Provider Information

NPI Number	:	1851960595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNWOODY BEHAVIORAL HEALTH CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 88567
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30356-8567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4594 BARCLAY DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-5883
Country	:	US
Telephone Number	:	404-951-6020
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	YOSEF SHUBAEV
Credential	:
Telephone Number	:	404-951-6020

Provider Enumeration Date	:	06/17/2021
Last Update Date	:	08/12/2021

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