Georgia Behavioral Campus LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

GEORGIA BEHAVIORAL CAMPUS LLC

Practice address

211 Goose Hollow Rd BLDG I
Reynolds, GA 31076-3505

Phone

(678) 769-6594

NPI assigned

Mar 20, 2024

Organization subpart

No

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

Authorized official

Name

Amber Blacklock

Title

Director of Finance

Phone

(678) 769-6594

Specialties & licenses 2

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1710892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710892800000",
    "number": "1770343584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 GOOSE HOLLOW RD BLDG I",
            "city": "REYNOLDS",
            "state": "GA",
            "postal_code": "310763505",
            "telephone_number": "678-769-6594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 GOOSE HOLLOW RD BLDG I",
            "city": "REYNOLDS",
            "state": "GA",
            "postal_code": "310763505",
            "telephone_number": "678-769-6594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA BEHAVIORAL CAMPUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-20",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A",
        "authorized_official_last_name": "BLACKLOCK",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "678-769-6594"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridges for Change, Inc.
• Jennifer Alison Broussard, NP
• Thomas Prier Callier IV, MD
• Ilana Diallo
• Angela Leigh Eubanks, MSN, PMHNP-BC
• Georgia Recovery Campus,LLC
• Laspanya Hunter
• Jonathan Julian Knight, PHARMD
• Tammi Martin Knight, PHARMD
• Macon County Medical Center

• Mental Illness Community Based Residential Treatment Facility in Reynolds, GA
• Providers in Reynolds, GA by specialty
• Mental Illness Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.