| East Conyers Behavioral Health Clinic | |
|
1277 Wellbrook Cir Ne Ste A Conyers GA 30012-3973 | |
| (770) 679-5453 | |
| (770) 679-5457 |
| Full Name | East Conyers Behavioral Health Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1277 Wellbrook Cir Ne Ste A, Conyers, Georgia |
| Authorized Official Name and Position | Selma Yallah (CO-OWNER) |
| Authorized Official Contact | 7706795453 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Conyers Behavioral Health Clinic 1277 Wellbrook Cir Ne Ste A Conyers GA 30012-3973 Ph: (770) 679-5453 | East Conyers Behavioral Health Clinic 1277 Wellbrook Cir Ne Ste A Conyers GA 30012-3973 Ph: (770) 679-5453 |
| NPI Number | 1710573936 |
|---|---|
| Provider Enumeration Date | 12/13/2020 |
| Last Update Date | 02/02/2021 |
| Certification Date | 02/02/2021 |
| Medicare PECOS PAC ID | 7911312335 |
|---|---|
| Medicare Enrollment ID | O20210217002173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710573936 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Selma Ali Yallah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831750975 PECOS PAC ID: 3375958796 Enrollment ID: I20210226001779 |
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