Provider Demographics
NPI:1174942684
Name:DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITIES, GA
Entity type:Organization
Organization Name:DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITIES, GA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-227-2990
Mailing Address - Street 1:400 S PINETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7128
Mailing Address - Country:US
Mailing Address - Phone:229-227-2990
Mailing Address - Fax:229-225-4052
Practice Address - Street 1:400 S PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7128
Practice Address - Country:US
Practice Address - Phone:229-227-2990
Practice Address - Fax:229-225-4052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF BEHAVIORAL HEALTH & DEVELOPMENTAL DISABILITITES, GA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30647208D00000X
GA514522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty