Organization
PEDIATRIC AND FAMILY BEHAVIORAL HEALTH OF GEORGIA
Active
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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