Pediatric and Family Behavioral Health of Georgia

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

PEDIATRIC AND FAMILY BEHAVIORAL HEALTH OF GEORGIA

Practice address

115 N Park TRL Ste 140
Stockbridge, GA 30281-7373

Phone

(404) 907-3982

Fax

(678) 775-8877

NPI assigned

Aug 21, 2020

Organization subpart

No

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

Authorized official

Name

Jovon Taylor

Title

Director

Phone

(404) 907-3982

Specialties & licenses 9

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jovon Erika Caldwell, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Atlanta, GA
  • NPI 1295372696
  Medicare reassignment NPD
• Shakirah Morgan

  • Clinical Social Worker
  • Historic New Castle, DE
  • NPI 1043874233
  NPD (past)

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

{
    "created_epoch": "1597968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1982216800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 WALTER WAY UNIT 2635",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819526",
            "telephone_number": "404-907-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 N PARK TRL STE 140",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817373",
            "telephone_number": "404-907-3982",
            "fax_number": "678-775-8877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND FAMILY BEHAVIORAL HEALTH OF GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-21",
        "last_updated": "2023-03-07",
        "certification_date": "2023-01-18",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JOVON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "404-907-3982"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC CERTIFICATION",
            "identifier": "2019050849",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14596139",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN/APRN LICENSE",
            "identifier": "RN233368",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peachtree Hospice of Georgia, LLC
• Peachtree Hospice of Georgia, LLC (BridgeWay Palliative Care)
• Jache Peaks, LMSW
• Shannon Lynn Pearce, PHYSICIAN ASSISTANT
• Allyson Pearson
• Pediatric Services of America, LLC (Aveanna Heatlhcare)
• Deanna Peisel, NNP
• Isamar Pena
• Penco Partners LLC
• Vincent T Peng, MD

• Psychiatry Physician in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.