Eastern Atlanta Behavioral Health LLC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

12100888 Issued in GA

Legal business name

EASTERN ATLANTA BEHAVIORAL HEALTH LLC

Practice address

1592 Mars Hill Rd Ste B
Watkinsville, GA 30677-4890

Phone

(706) 705-1687

Fax

(706) 705-1654

NPI assigned

Jan 19, 2013

Last updated

Aug 28, 2020By 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

Roberto Norniella Norniella, M.D.NPI 1487609830

Title

Ceo

Phone

(706) 705-1687

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

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.

• Roberto Norniella, MD

  • Psychiatry Physician
  • Monroe, GA
  • NPI 1487609830
  Medicare reassignment Authorized official
• Angella Samuels, DNP

  • Nurse Practitioner
  • Snellville, GA
  • NPI 1043406069
  NPD (past)

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

{
    "created_epoch": "1358553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598572800000",
    "number": "1326386780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1592 MARS HILL RD STE B",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774890",
            "telephone_number": "706-705-1687",
            "fax_number": "706-705-1654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1592 MARS HILL RD STE B",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306774890",
            "telephone_number": "706-705-1687",
            "fax_number": "706-705-1654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN ATLANTA BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-19",
        "last_updated": "2020-08-28",
        "certification_date": "2020-08-26",
        "status": "A",
        "authorized_official_last_name": "NORNIELLA",
        "authorized_official_first_name": "ROBERTO",
        "authorized_official_middle_name": "NORNIELLA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-705-1687",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "12100888",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Benjamin Dwyer, LMSW
• Annah Grace Dye
• Amanda Dix Dyer, PH.D.
• Mark Alan Earhart, M.D.
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• Chaz Ebert, DC
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• Kelsey Edenfield, BCBA

• Psychiatry Physician in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.