Evergreen Behavioral Management of Georgia, Inc.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

EVERGREEN BEHAVIORAL MANAGEMENT OF GEORGIA, INC.

Practice address

8657 Hospital Dr
Suite 101 a
Douglasville, GA 30134-2298

Phone

(770) 949-3118

Fax

(770) 949-3228

NPI assigned

Jul 10, 2007

Last updated

Jul 22, 2008By the provider in NPPES

Organization subpart

Yes

Parent organization

EVERGREEN BEHAVIORAL MANAGEMENT, INC.As reported in NPPES

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

Authorized official

Name

Ms. Ginger G Gore

Title

Ceo

Phone

(910) 641-0600

Specialties & licenses 1

Addresses

Part of

Evergreen Management

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1548468762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 425",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284720425",
            "telephone_number": "910-641-0600",
            "fax_number": "910-641-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8657 HOSPITAL DR",
            "address_2": "SUITE 101 A",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301342298",
            "telephone_number": "770-949-3118",
            "fax_number": "770-949-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN BEHAVIORAL MANAGEMENT OF GEORGIA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN BEHAVIORAL MANAGEMENT, INC.",
        "enumeration_date": "2007-07-10",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "GORE",
        "authorized_official_first_name": "GINGER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-641-0600",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2008; 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.