Southern Behavioral Healthcare,P.C

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

051606 Issued in GA

Legal business name

SOUTHERN BEHAVIORAL HEALTHCARE,P.C

Practice address

110 Braxton CT
Fayetteville, GA 30214-1968

Phone

(678) 610-7100

Fax

(678) 610-7111

NPI assigned

Mar 4, 2006

Last updated

Sep 14, 2022By 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

Mrs. Salewa Taiwo

Title

Office Manager

Phone

(678) 610-7100

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 7

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.

• Karen Denise Amos, APRN

  • Nurse Practitioner
  • Fayetteville, GA
  • NPI 1851830533
  Medicare reassignment Care Compare group NPD
• Olufemi Abiodun Taiwo, M.D

  • Child & Adolescent Psychiatry Physician
  • Fayetteville, GA
  • NPI 1225005598
  Medicare reassignment Care Compare group NPD
• Carla Ann Alexander, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fayetteville, GA
  • NPI 1770070120
  NPD (past)
• Olumuyiwa Joshua, MD

  • Critical Care Medicine (Internal Medicine) Physician
  • Fayetteville, GA
  • NPI 1144322157
  NPD (past)
• Taiwo Olushola Odedeyi, M.D

  • Child & Adolescent Psychiatry Physician
  • Jonesboro, GA
  • NPI 1124334628
  NPD (past)
• Amia Lynn Washington, NP

  • Psychiatric/Mental Health Nurse Practitioner
  • Fayetteville, GA
  • NPI 1801538913
  NPD (past)
• Fallon Wortham

  • Psychiatric/Mental Health Nurse Practitioner
  • Fayetteville, GA
  • NPI 1346010899
  NPD (past)

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

{
    "created_epoch": "1141430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663113600000",
    "number": "1598732869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 BRAXTON CT",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141968",
            "telephone_number": "678-610-7100",
            "fax_number": "678-610-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BRAXTON CT",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302141968",
            "telephone_number": "678-610-7100",
            "fax_number": "678-610-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN BEHAVIORAL HEALTHCARE,P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-04",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A",
        "authorized_official_last_name": "TAIWO",
        "authorized_official_first_name": "SALEWA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "678-610-7100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "GA",
            "license": "64622",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "GA",
            "license": "051606",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Child & Adolescent Psychiatry Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Child & Adolescent Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; 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.