| Vitalis Behavioral Health | |
|
3091 Battlefield Pkwy Fort Oglethorpe GA 30742-4003 | |
| (706) 841-0500 | |
| Not Available |
| Full Name | Vitalis Behavioral Health |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 3091 Battlefield Pkwy, Fort Oglethorpe, Georgia |
| Authorized Official Name and Position | Denise Goodwin (CLINICAL DIRECTOR) |
| Authorized Official Contact | 7068410500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitalis Behavioral Health 3091 Battlefield Pkwy Fort Oglethorpe GA 30742-4003 Ph: (706) 841-0500 | Vitalis Behavioral Health 3091 Battlefield Pkwy Fort Oglethorpe GA 30742-4003 Ph: (706) 841-0500 |
| NPI Number | 1285271528 |
|---|---|
| Provider Enumeration Date | 12/05/2019 |
| Last Update Date | 08/21/2020 |
| Certification Date | 08/21/2020 |
| Medicare PECOS PAC ID | 8729414891 |
|---|---|
| Medicare Enrollment ID | O20200208000196 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285271528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Matthew Mcumber |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851811780 PECOS PAC ID: 2769758234 Enrollment ID: I20171027001534 |
| Provider Name | Denise Rachel Goodwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407377831 PECOS PAC ID: 6901159649 Enrollment ID: I20181029000116 |
| Provider Name | Elizabeth Mary Day |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720038870 PECOS PAC ID: 9537592092 Enrollment ID: I20191214000023 |
| Provider Name | April E Crumpler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346941358 PECOS PAC ID: 6507227204 Enrollment ID: I20230727002478 |
| Provider Name | Kimberly Luke Keen |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1891497053 PECOS PAC ID: 4880069665 Enrollment ID: I20231226001679 |
| Provider Name | Claire Blackmon Ivy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336874528 PECOS PAC ID: 3375980022 Enrollment ID: I20240318002347 |
North Georgia Behavioral Therapy Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1638 Battlefield Pkwy, Fort Oglethorpe, GA 30742 Phone: 423-805-9888 | |
Northwest Georgia Treatment Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2007 Old Lafayette Rd, Fort Oglethorpe, GA 30742 Phone: 706-861-9390 Fax: 706-866-4740 |