| Bagley Youth Development | |
|
2245 Godby Rd Suite 206 College Park GA 30349-5059 | |
| (404) 968-4662 | |
| (404) 968-4562 |
| Full Name | Bagley Youth Development |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2245 Godby Rd, College Park, Georgia |
| Authorized Official Name and Position | Georgiana Bagley (CEO) |
| Authorized Official Contact | 4049684662 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bagley Youth Development 375 Windermere Cir Newnan GA 30265-2278 Ph: (678) 362-7802 | Bagley Youth Development 2245 Godby Rd Suite 206 College Park GA 30349-5059 Ph: (404) 968-4662 |
| NPI Number | 1811034317 |
|---|---|
| Provider Enumeration Date | 01/31/2007 |
| Last Update Date | 05/19/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811034317 | NPI | - | NPPES |
| 503205308A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC001132 (Georgia) | Primary |
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