Organization
PEDIATRIC AND FAMILY BEHAVIORAL HEALTH OF GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOVON TAYLOR (DIRECTOR)
(404) 907-3982
Entity
Organization
Contact information
Practice address
115 N PARK TRL STE 140, STOCKBRIDGE, GA 30281-7373
(404) 907-3982
(678) 775-8877
Mailing address
110 WALTER WAY UNIT 2635, STOCKBRIDGE, GA 30281-9526
(404) 907-3982
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14596139
CAQH
—
01
—
2019050849
ANCC CERTIFICATION
—
01
—
RN233368
RN/APRN LICENSE
GA
Enumeration date
08/21/2020
Last updated
03/07/2023
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