| Mcintosh Trail Community Service Board | |
|
1459 Williamson Rd Griffin GA 30224-8428 | |
| (770) 229-3000 | |
| Not Available |
| Full Name | Mcintosh Trail Community Service Board |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1459 Williamson Rd, Griffin, Georgia |
| Authorized Official Name and Position | Pamela Mccollum (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7703588251 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcintosh Trail Community Service Board 1501a Kalamazoo Dr Griffin GA 30224-3919 Ph: (770) 358-8250 | Mcintosh Trail Community Service Board 1459 Williamson Rd Griffin GA 30224-8428 Ph: (770) 229-3000 |
| NPI Number | 1336317270 |
|---|---|
| Provider Enumeration Date | 02/13/2008 |
| Last Update Date | 08/11/2015 |
| Medicare PECOS PAC ID | 6204818669 |
|---|---|
| Medicare Enrollment ID | O20040601001239 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336317270 | NPI | - | NPPES |
| 000601609J | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Carol A Lyle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568573871 PECOS PAC ID: 7517975014 Enrollment ID: I20060324000346 |
| Provider Name | Leigh Anne C Harvey |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265598395 PECOS PAC ID: 8123020997 Enrollment ID: I20070207000308 |
| Provider Name | Monica Smith |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346258795 PECOS PAC ID: 3678670866 Enrollment ID: I20070523000248 |
| Provider Name | Jonathan Steven Williams |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1346391299 PECOS PAC ID: 6507954799 Enrollment ID: I20071126000151 |
| Provider Name | Melanie C Fisher |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1356360150 PECOS PAC ID: 4789737479 Enrollment ID: I20090728000536 |
| Provider Name | Kingsley E Iyamu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1275615171 PECOS PAC ID: 0941341978 Enrollment ID: I20100112000736 |
| Provider Name | Lenora Allen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528199163 PECOS PAC ID: 4880889914 Enrollment ID: I20101115000319 |
| Provider Name | Terrie H Allen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407109267 PECOS PAC ID: 7113170986 Enrollment ID: I20130102000316 |
| Provider Name | Jamil Eman Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376882191 PECOS PAC ID: 3274778568 Enrollment ID: I20130313000553 |
| Provider Name | Rena Castlin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619216892 PECOS PAC ID: 4082851829 Enrollment ID: I20130514000690 |
| Provider Name | Ceretha Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124061791 PECOS PAC ID: 1951482900 Enrollment ID: I20130725000876 |
| Provider Name | Jill M Harrison |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518192293 PECOS PAC ID: 9739314774 Enrollment ID: I20131030000296 |
| Provider Name | Jamie A Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124363874 PECOS PAC ID: 4789803685 Enrollment ID: I20140908001548 |
| Provider Name | Angeletta M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447687512 PECOS PAC ID: 5698098929 Enrollment ID: I20141217002744 |
| Provider Name | Ana M Cuebas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417277997 PECOS PAC ID: 9335466754 Enrollment ID: I20150324002122 |
| Provider Name | Sangeetha Venkataramanan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528383148 PECOS PAC ID: 0648598060 Enrollment ID: I20150415002192 |
| Provider Name | Denise Hanak Atkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497136576 PECOS PAC ID: 2961719042 Enrollment ID: I20150922002580 |
| Provider Name | Terrill Anthony Cooper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487001798 PECOS PAC ID: 3678867686 Enrollment ID: I20160812001383 |
| Provider Name | Jessica N Battle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700254364 PECOS PAC ID: 8022305721 Enrollment ID: I20160923000771 |
| Provider Name | Candice Nipp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699128595 PECOS PAC ID: 8426337395 Enrollment ID: I20161116002364 |
| Provider Name | Charlene S Pugh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538330170 PECOS PAC ID: 5698050078 Enrollment ID: I20170327002475 |
| Provider Name | Lisa M Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609395110 PECOS PAC ID: 1456601269 Enrollment ID: I20180828004172 |
| Provider Name | Manisha Vijay Shroff |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1699708750 PECOS PAC ID: 9234134404 Enrollment ID: I20181003003393 |
| Provider Name | Jennifer Schafer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548748379 PECOS PAC ID: 4385989532 Enrollment ID: I20181217003115 |
| Provider Name | Gloria Chine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386128320 PECOS PAC ID: 6800129669 Enrollment ID: I20190610002258 |
| Provider Name | Dherby Georges-ramdeen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700373685 PECOS PAC ID: 9638402407 Enrollment ID: I20190610002583 |
| Provider Name | Okechukwu Nnaji |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619459542 PECOS PAC ID: 4284967910 Enrollment ID: I20190611002737 |
| Provider Name | Shauna Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366933558 PECOS PAC ID: 9638406929 Enrollment ID: I20190808003434 |
| Provider Name | Tremeze Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477076792 PECOS PAC ID: 7618204918 Enrollment ID: I20190808003981 |
| Provider Name | Nadia Tayeb |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1952747198 PECOS PAC ID: 3274821046 Enrollment ID: I20190828004071 |
| Provider Name | Emily K Hebert Buck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760881700 PECOS PAC ID: 6305222167 Enrollment ID: I20220930001909 |
| Provider Name | Teresa Cagle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902478852 PECOS PAC ID: 0244601862 Enrollment ID: I20230118002686 |
| Provider Name | Crystal M Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164126850 PECOS PAC ID: 1456707363 Enrollment ID: I20231030001888 |
| Provider Name | Gabrielle M Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215607742 PECOS PAC ID: 7911353776 Enrollment ID: I20231031000209 |
| Provider Name | Precious G Evangelista |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760102487 PECOS PAC ID: 2567819956 Enrollment ID: I20231107000779 |
| Provider Name | Farah S James |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174232813 PECOS PAC ID: 5193172021 Enrollment ID: I20231114001768 |
| Provider Name | Christine R Hunter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1992271001 PECOS PAC ID: 7517303795 Enrollment ID: I20240311000888 |
| Provider Name | Cecile M Dunkley Layne |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1114550571 PECOS PAC ID: 0042650822 Enrollment ID: I20240426000850 |
| Provider Name | Carline M Scutt |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912363813 PECOS PAC ID: 6406296284 Enrollment ID: I20240426000867 |
| Provider Name | Evelyn C Strozier |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336775626 PECOS PAC ID: 6406296169 Enrollment ID: I20240429000211 |
| Provider Name | Tiffany A Taylor |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1598188716 PECOS PAC ID: 0042650731 Enrollment ID: I20240429001323 |
| Provider Name | Diamesha D Walton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1215350368 PECOS PAC ID: 7810334570 Enrollment ID: I20240502000172 |
| Provider Name | Jenise T Clark |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851880926 PECOS PAC ID: 9335589407 Enrollment ID: I20240507000555 |
| Provider Name | Tracy L Mclean |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487244612 PECOS PAC ID: 8325488414 Enrollment ID: I20240507001344 |
Mcintosh Trail Community Service Board Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 221 Laurel Street, Griffin, GA 30224 Phone: 770-229-3125 | |
De-stress Spa & Treatment Centers, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1545 N Expressway Ste 117, Griffin, GA 30223 Phone: 404-956-9970 | |
Renewing Hope Llc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2896 N Expressway Ste A, Griffin, GA 30223 Phone: 470-771-8182 | |
Ceed Community Enrichment, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 228 E Poplar St Ste C, Griffin, GA 30224 Phone: 678-408-0109 | |
Mental Expressions Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 730 Anne St, Griffin, GA 30224 Phone: 770-624-9881 | |
Plaza Consultants Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 333 South 9th Street, Griffin, GA 30224 Phone: 770-229-8721 Fax: 770-228-4508 | |
Total Control Behavioral Health Center Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 210 S 13th St, Griffin, GA 30224 Phone: 470-204-7956 Fax: 866-217-7073 |