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Organization

DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL DISABILITIES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. EMILE RISBY M.D. (CLINICAL DIRECTOR)
(404) 243-2114
Entity
Organization

Contact information

Practice address
3073 PANTHERSVILLE RD, DECATUR, GA 30034-3828
(404) 212-5454
(404) 243-2159
Mailing address
PO BOX 370407, DECATUR, GA 30037-0407
(404) 212-5454
(404) 243-2159

Taxonomy

Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
044-232
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000141061A
GA
Enumeration date
06/08/2009
Last updated
03/26/2010
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