Organization
RIVER EDGE BEHAVIORAL HEALTH CENTER
Active
Parent organization
RIVER EDGE BEHAVIORAL HEALTH CENTER
Other names
River Edge Boulevard Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
RIVER EDGE BEHAVIORAL HEALTH CENTER
Authorized official
JESSICA OAKES DO (BILLING MANAGER)
(478) 803-7809
Entity
Organization
Contact information
Practice address
265 BOULEVARD NE, ATLANTA, GA 30312-1208
(404) 665-8550
(404) 665-8693
Mailing address
175 EMERY HWY, MACON, GA 31217-3692
(478) 803-7700
(478) 803-8598
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHRE010434
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHRE010434
GEORGIA PHARMACY LICENSE
GA
Enumeration date
08/29/2018
Last updated
08/29/2018
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