Pathways Center for Behavioral and Developmental Growth
Organization Active NPI Community/Behavioral Health Agency · Newnan, GA
NPI 1295897254 · NPPES record last updated Jun 30, 2016
Key facts
- NPI
- 1295897254
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH
- Practice address
- 59 Hospital Rd
Newnan, GA 30263-1209 - Phone
- (678) 423-4610
- Fax
- (770) 254-7419
- NPI assigned
- Dec 15, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH
Authorized official
- Name
- Jade Russell Benefield, MBA
- Title
- Executive Director
- Phone
- (706) 845-4045
Other NPIs on the same Medicare enrollment 9
Practitioners 10
-
Rugiatu Bahr, NP
-
Franchon Renee Carter, PA-C
-
Linda Joy Knight-Nelson, M.D.
-
Chinasa Ogbobe, PMHNP-BC
-
Sheri Raymond, LPN
-
Frederick L. Smith, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040430000883 | GA | Part B Supplier - Clinic/Group Practice | 5193712073 |
Receives reassigned benefits from 23 practitioners 9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Carrollton, GA; Franklin, GA; Greenville, GA; Griffin, GA; Lagrange, GA; Newnan, GA |
National Provider Directory
- Part of
- Pathways Center CSB
Locations
153 Independence Dr
Carrollton, GA 30116
Phone (770) 836-6678
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
59 Hospital Rd
Newnan, GA 30263-1209
Mailing address
122 Gordon Commercial Drive
Suite C
Lagrange, GA 30240-5740
Phone (706) 845-4045
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000599332N | Medicaid | GA |
Other providers in Newnan, GA
- Vishalee Patel
- Pathways Center for Behavioral & Developmental Growth
- Pathways Center for Behavioral and Developmental Disabilities
- Pathways Center for Behavioral and Developmental Growth
- Pathways Center for Behavioral and Developmental Growth
- Pathways Center for Behavioral and Developmental Growth
- Pathways Center for Behavioral and Developmental Growth
- Patrick H Yancey III DMD
- Courtney Taylor Patterson
- Erika Patterson
All providers in Newnan, GA · Community/Behavioral Health Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 30, 2016. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.