NPIMap

Organization Active NPI

Wayne Behavorial Health Services

  • Preferred Provider Organization
  • Jesup, GA
National Provider Identifier
1740433036
Registry record updated Oct 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
002644 Issued in GA
Legal business name
WAYNE BEHAVORIAL HEALTH SERVICES
Practice address
1245 S 1St St
Jesup, GA 31545-7729
Phone
(912) 427-1499
Fax
(912) 427-2358
NPI assigned
Oct 30, 2008
Last updated
Oct 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2008

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

Authorized official

Name
Mrs. Jennifer C Mann-Mackey, LPCNPI 1790940484
Title
Director of Behavioral Health/LPC
Phone
(912) 427-1499

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 002644 GA
Preferred Provider Organization 305R00000X 002644 GA Primary

Addresses

Primary practice location

1245 S 1St St
Jesup, GA 31545-7729

Mailing address

PO Box 37
1245 South 1St Street
Jesup, GA 31598-0037
Phone (912) 427-1499

Other identifiers 2

IdentifierTypeStateIssuer
369579212AMedicaidGA
369579212MedicaidGA

National Provider Directory

National Provider Directory

Locations

1245 S 1st St
Jesup, GA 31545
Phone (912) 385-2627

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1225324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225324800000",
    "number": "1740433036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37",
            "address_2": "1245 SOUTH 1ST STREET",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315980037",
            "telephone_number": "912-427-1499",
            "fax_number": "912-427-2358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 S 1ST ST",
            "city": "JESUP",
            "state": "GA",
            "postal_code": "315457729",
            "telephone_number": "912-427-1499",
            "fax_number": "912-427-2358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNE BEHAVORIAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-30",
        "last_updated": "2008-10-30",
        "status": "A",
        "authorized_official_last_name": "MANN-MACKEY",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR OF BEHAVIORAL HEALTH/LPC",
        "authorized_official_telephone_number": "912-427-1499",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "GA",
            "license": "002644",
            "primary": false
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "GA",
            "license": "002644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "369579212A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "369579212",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jesup, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 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.