NPIMap

Organization Active NPI

Willow Oak Community Behavioral Health Center

Doing business as Willow Oak Center

  • Community/Behavioral Health Agency
  • Newnan, GA
National Provider Identifier
1881131860
Registry record updated Mar 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
WILLOW OAK COMMUNITY BEHAVIORAL HEALTH CENTER
Doing business as
Willow Oak Center
Practice address
55 Jefferson Pkwy # 55B
Newnan, GA 30263-5813
Phone
(770) 683-6946
Fax
(770) 683-6949
NPI assigned
Jan 27, 2017
Last updated
Mar 18, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2026

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

Authorized official

Name
Ms. Diane BoulaiNPI 1437442803
Title
Ceo/ Owner
Phone
(678) 477-3476

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Community/Behavioral Health Agency 251S00000X NU Primary
Integrative Medicine Physician 202D00000X NU

Addresses

Primary practice location

55 Jefferson Pkwy # 55B
Newnan, GA 30263-5813

Mailing address

361 Cliffhaven Cir
Newnan, GA 30263-6358
Phone (678) 477-3476

Other identifiers 1

IdentifierTypeStateIssuer
003218948AMedicaidGA

Other names 1

  • Willow Oak Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200413002764 GA Part B Supplier - Clinic/Group Practice 4981034097 Receives reassigned benefits from 12 practitioners
Practice locations: Riverdale, GA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2128353Willow Oak Community55 Jefferson Parkway, Newnan, GA 30263Certificate of waiverMar 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Willow Oak Comm BH Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

37 Calumet Pkwy
Ste J101
Newnan, GA 30263
Phone (770) 683-6946

37 Calumet Pkwy
Ste J102
Newnan, GA 30263

55 Jefferson Pkwy
#55B
Newnan, GA 30263
Phone (770) 683-6946

55 Jefferson Pkwy
Ste 55B
Newnan, GA 30263
Phone (770) 683-6946

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1485475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1881131860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "361 CLIFFHAVEN CIR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302636358",
            "telephone_number": "678-477-3476",
            "fax_number": "770-683-6949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 JEFFERSON PKWY # 55B",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302635813",
            "telephone_number": "770-683-6946",
            "fax_number": "770-683-6949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW OAK COMMUNITY BEHAVIORAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-27",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A",
        "authorized_official_last_name": "BOULAI",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "CEO/ OWNER",
        "authorized_official_telephone_number": "678-477-3476",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "",
            "desc": "Integrative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003218948A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willow Oak Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newnan, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.