Community Based Healthcare Services

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

COMMUNITY BASED HEALTHCARE SERVICES

Practice address

2374 Main St Ste B
Tucker, GA 30084-4533

Phone

(678) 964-7107

NPI assigned

Jul 23, 2013

Last updated

Jul 23, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Derrick Boswell Jr., BS PSYCHOLOGY

Title

Director

Phone

(678) 964-7107

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374537600000",
    "number": "1316389901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2374 MAIN ST STE B",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844533",
            "telephone_number": "678-964-7107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2374 MAIN ST STE B",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844533",
            "telephone_number": "678-964-7107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY BASED HEALTHCARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2013-07-23",
        "status": "A",
        "authorized_official_last_name": "BOSWELL",
        "authorized_official_first_name": "DERRICK",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "678-964-7107",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "BS PSYCHOLOGY"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Preferred Provider Organization in Tucker, GA
• Providers in Tucker, GA by specialty
• Preferred Provider Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.