NPIMap

Organization Active NPI

Unison Behavioral Health

Doing business as Charlton BHS Outpatient

  • Community/Behavioral Health Agency
  • Folkston, GA
National Provider Identifier
1003125287
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
UNISON BEHAVIORAL HEALTH
Doing business as
Charlton BHS Outpatient
Practice address
396 Kingsland Dr
Folkston, GA 31537-2850
Phone
(912) 449-7109
Fax
(912) 449-7056
NPI assigned
Oct 5, 2010
Last updated
Sep 30, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
UNISON BEHAVIORAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Glyn Thomas, PHD
Title
Ceo
Phone
(912) 449-7103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

396 Kingsland Dr
Folkston, GA 31537-2850

Mailing address

1007 Mary St
Waycross, GA 31503-3823
Phone (912) 449-7109

Other names 2

  • Charlton BHS Outpatient Doing business as
  • Charlton C&A Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040220000112 GA Part B Supplier - Clinic/Group Practice 7517852247 Receives reassigned benefits from 33 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waycross, GA; Nahunta, GA; Folkston, GA; Homerville, GA; Alma, GA; Douglas, GA

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2182033Unison Behavioral Health - Charlton BH396 Kingsland Drive, Folkston, GA 31537Certificate of waiverApr 14, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ernestine Nelson71 organizations share this tax ID, including this one
Part of
Ernestine Nelson

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

172 Homeland Park Rd
Folkston, GA 31537
Phone (912) 496-7460

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/unisonbehavioralhealth/r4/

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1003125287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 MARY ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315033823",
            "telephone_number": "912-449-7109",
            "fax_number": "912-449-7056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 KINGSLAND DR",
            "city": "FOLKSTON",
            "state": "GA",
            "postal_code": "315372850",
            "telephone_number": "912-449-7109",
            "fax_number": "912-449-7056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNISON BEHAVIORAL HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNISON BEHAVIORAL HEALTH",
        "enumeration_date": "2010-10-05",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "GLYN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-449-7103",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charlton BHS Outpatient",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Charlton C&A",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Charlton C&A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Folkston, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.