Provider Demographics
NPI:1316350457
Name:SPRINGHEALTH BEHAVIORAL HEALTH AND INTEGRATED CARE GEORGIA, LLC
Entity type:Organization
Organization Name:SPRINGHEALTH BEHAVIORAL HEALTH AND INTEGRATED CARE GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHOBREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-630-7249
Mailing Address - Street 1:805 N WHITTINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7101
Mailing Address - Country:US
Mailing Address - Phone:502-297-0133
Mailing Address - Fax:502-297-0289
Practice Address - Street 1:1705 RIVER ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601
Practice Address - Country:US
Practice Address - Phone:502-297-0133
Practice Address - Fax:502-297-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty