BHG Lxvi, LLC
Organization Active NPI Addiction Medicine (Psychiatry & Neurology) Physician · Tifton, GA
NPI 1043914591 · NPPES record last updated Apr 7, 2025
Key facts
- NPI
- 1043914591
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Addiction Medicine (Psychiatry & Neurology) Physician 2084A0401X
- Legal business name
- BHG LXVI, LLC
- Practice address
- 2402 Tift Avenue North
Suite #202, Obot Room #100
Tifton, GA 31794-1885 - Phone
- (229) 382-7808
- Fax
- (229) 386-5818
- NPI assigned
- Mar 29, 2023
- Organization subpart
- No
Authorized official
- Name
- Zack Ragsdale
- Title
- Director
- Phone
- (512) 454-5911
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 3
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2300582 | BHG Lxvi, LLC Dba BHG Medical Services - Georgia | Certificate of waiver | Mar 12, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211105000986 | GA | Part B Supplier - Clinic/Group Practice | 4981093325 |
Receives reassigned benefits from 6 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tifton, GA; Jackson, GA; Albany, GA; Bremen, GA |
National Provider Directory
- Tax ID family
- BHG Lxvi LLC
Locations
2402 Tift Ave N
Ste 202
Tifton, GA 31794
Phone (229) 382-7808
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor |
101YA0400X | |||
| Addiction Medicine (Anesthesiology) Physician |
207LA0401X | |||
| Addiction Medicine (Family Medicine) Physician |
207QA0401X | |||
| Addiction Medicine (Internal Medicine) Physician |
207RA0401X | |||
| Addiction Medicine (Preventive Medicine) Physician |
2083A0300X | |||
| Addiction Medicine (Psychiatry & Neurology) Physician |
2084A0401X | Yes | ||
| Nurse Practitioner |
363L00000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
2402 Tift Avenue North
Suite #202, Obot Room #100
Tifton, GA 31794-1885
Mailing address
5001 Spring Valley Road
Suite 600 East
Dallas, TX 75244-3946
Phone (214) 365-6100
Other names
- BHG Medical Services - Georgia
Other providers in Tifton, GA
- Jessica Whitehead Beier
- Allison Marie Bell
- Christy Bell
- Linsey Brooke Bennett
- Brittney W Berckman
- BHG XLV, LLC
- Corey Allen Bichel
- Brittney Billington
- Garrett Blalock
- Kathryn Blevins
All providers in Tifton, GA · Addiction Medicine (Psychiatry & Neurology) Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.