Greenlee Behavioral Health Services, Llc. | |
778 Rays Rd Suite 102 Stone Mountain GA 30083-3107 | |
(404) 298-1230 | |
Not Available |
Full Name | Greenlee Behavioral Health Services, Llc. |
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Speciality | Community/Behavioral Health |
Location | 778 Rays Rd, Stone Mountain, Georgia |
Authorized Official Name and Position | Tiffany Lasha Wiggins (OWNER/CEO) |
Authorized Official Contact | 4042981230 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Greenlee Behavioral Health Services, Llc. 778 Rays Rd Suite 102 Stone Mountain GA 30083-3107 Ph: (404) 298-1230 | Greenlee Behavioral Health Services, Llc. 778 Rays Rd Suite 102 Stone Mountain GA 30083-3107 Ph: (404) 298-1230 |
NPI Number | 1881968584 |
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Provider Enumeration Date | 02/28/2012 |
Last Update Date | 02/28/2012 |
Medicare PECOS PAC ID | 8325426976 |
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Medicare Enrollment ID | O20220609002525 |
Identifier | Type | State | Issuer |
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1881968584 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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251S00000X | Community/behavioral Health | 453088947A (Georgia) | Primary |
Provider Name | Hemachandra P Gunawardhana |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1558369413 PECOS PAC ID: 6002851672 Enrollment ID: I20110124000875 |
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