| Georgia Behavioral Health Practitioner Clinic | |
|
2206 Hanfred Ln Ste 103 Tucker GA 30084-4809 | |
| (678) 831-6429 | |
| (687) 668-2848 |
| Full Name | Georgia Behavioral Health Practitioner Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2206 Hanfred Ln Ste 103, Tucker, Georgia |
| Authorized Official Name and Position | Louise Wise (PROVIDER) |
| Authorized Official Contact | 6788316429 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Georgia Behavioral Health Practitioner Clinic Po Box 309 Clarkston GA 30021-0309 Ph: (678) 368-5561 | Georgia Behavioral Health Practitioner Clinic 2206 Hanfred Ln Ste 103 Tucker GA 30084-4809 Ph: (678) 831-6429 |
| NPI Number | 1699239475 |
|---|---|
| Provider Enumeration Date | 01/26/2019 |
| Last Update Date | 04/09/2023 |
| Certification Date | 04/09/2023 |
| Medicare PECOS PAC ID | 1951768613 |
|---|---|
| Medicare Enrollment ID | O20230612001657 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699239475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Louise Wise |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851782965 PECOS PAC ID: 3577866086 Enrollment ID: I20160115001840 |
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