NPIMap

Organization Active NPI

River Edge Behavioral Health Center

Doing business as River Edge Boulevard Pharmacy

  • Community/Retail Pharmacy
  • Atlanta, GA
National Provider Identifier
1972085769
Registry record updated Aug 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHRE010434 Issued in GA
Legal business name
RIVER EDGE BEHAVIORAL HEALTH CENTER
Doing business as
River Edge Boulevard Pharmacy
Practice address
265 Boulevard NE
Atlanta, GA 30312-1208
Phone
(404) 665-8550
Fax
(404) 665-8693
NPI assigned
Aug 29, 2018
Last updated
Aug 29, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVER EDGE BEHAVIORAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 29, 2018

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

Authorized official

Name
Jessica Oakes, DO
Title
Billing Manager
Phone
(478) 803-7809

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHRE010434 GA Primary

Addresses

Primary practice location

265 Boulevard NE
Atlanta, GA 30312-1208

Mailing address

175 Emery Hwy
Macon, GA 31217-3692
Phone (478) 803-7700

Other identifiers 1

IdentifierTypeStateIssuer
PHRE010434OtherGAGEORGIA PHARMACY LICENSE

Other names 1

  • River Edge Boulevard Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
River Edge Recovery Center Pharmacy77 organizations share this tax ID, including this one
Part of
River Edge Recovery Center Pharmacy

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

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

{
    "created_epoch": "1535500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535500800000",
    "number": "1972085769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 EMERY HWY",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173692",
            "telephone_number": "478-803-7700",
            "fax_number": "478-803-8598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 BOULEVARD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121208",
            "telephone_number": "404-665-8550",
            "fax_number": "404-665-8693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER EDGE BEHAVIORAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVER EDGE BEHAVIORAL HEALTH CENTER",
        "enumeration_date": "2018-08-29",
        "last_updated": "2018-08-29",
        "status": "A",
        "authorized_official_last_name": "OAKES",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "478-803-7809",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE010434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA PHARMACY LICENSE",
            "identifier": "PHRE010434",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Edge Boulevard Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2018; 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.