| Pediatric And Family Behavioral Health Of Georgia | |
|
115 N Park Trl Ste 140 Stockbridge GA 30281-7373 | |
| (404) 907-3982 | |
| (678) 775-8877 |
| Full Name | Pediatric And Family Behavioral Health Of Georgia |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 115 N Park Trl Ste 140, Stockbridge, Georgia |
| Authorized Official Name and Position | Jovon Taylor (DIRECTOR) |
| Authorized Official Contact | 4049073982 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric And Family Behavioral Health Of Georgia 110 Walter Way Unit 2635 Stockbridge GA 30281-9526 Ph: (404) 907-3982 | Pediatric And Family Behavioral Health Of Georgia 115 N Park Trl Ste 140 Stockbridge GA 30281-7373 Ph: (404) 907-3982 |
| NPI Number | 1982216800 |
|---|---|
| Provider Enumeration Date | 08/21/2020 |
| Last Update Date | 03/07/2023 |
| Certification Date | 01/18/2023 |
| Medicare PECOS PAC ID | 6901204098 |
|---|---|
| Medicare Enrollment ID | O20211004001547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982216800 | NPI | - | NPPES |
| 2019050849 | Other | ANCC CERTIFICATION | |
| 14596139 | Other | CAQH | |
| RN233368 | Other | GA | RN/APRN LICENSE |
| Provider Name | Jovon Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295372696 PECOS PAC ID: 9234567926 Enrollment ID: I20200311001332 |
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