Pine Lake Behavioral Services

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PINE LAKE BEHAVIORAL SERVICES

Practice address

433 Hemlock Drive
Pine Lake, GA 30072

Phone

(404) 298-6263

NPI assigned

Mar 19, 2009

Last updated

Mar 19, 2009By 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

Jerry McMahon

Title

General Partner

Phone

(404) 298-6263

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1237420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237420800000",
    "number": "1801037957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1502",
            "city": "PINE LAKE",
            "state": "GA",
            "postal_code": "300721502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 HEMLOCK DRIVE",
            "city": "PINE LAKE",
            "state": "GA",
            "postal_code": "30072",
            "telephone_number": "404-298-6263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE LAKE BEHAVIORAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-19",
        "last_updated": "2009-03-19",
        "status": "A",
        "authorized_official_last_name": "MCMAHON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "404-298-6263"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Pine Lake, GA
• Providers in Pine Lake, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2009; 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.