Basic Information
| Provider Information | |||||||||
| NPI: | 1316663719 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER BEHAVIORAL SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2003 GODWIN AVE STE B | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106711111 | ||||||||
| FaxNumber: | 9106714454 | ||||||||
| Practice Location | |||||||||
| Address1: | 203 MEDICAL WAY STE B | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302742517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102587886 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2022 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | AUGUSTINE | ||||||||
| AuthorizedOfficialFirstName: | SANTHOSH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9107332007 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PREMIER BEHAVIORAL SERVICES INC | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.