RAVENS NEST FOUNDATION INC
NPI 1578867982
Clinic/Center - Mental Health (Including Community Mental Health Center) in Austell, GA

Q: What is Ravens Nest Foundation Inc's NPI number?

The NPI number for Ravens Nest Foundation Inc is 1578867982. It was assigned to this organization in the NPPES registry on December 28, 2010.

Q: What is Ravens Nest Foundation Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Active since December 28, 2010

1680 MULKEY RD STE 200, AUSTELL, GA 30106(770) 819-6825(770) 819-6826 Get Directions Write a Review

NPPES record last updated: January 28, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jan 28, 2026, Dec 31, 2025, Mar 27, 2020 (3 updates tracked since 2020).

On this page

About Ravens Nest Foundation Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RAVENS NEST FOUNDATION INC (NPI 1578867982) is a healthcare organization registered as a mental health (including community mental health center) in Austell, Georgia and active in the NPI registry since December 2010. The organization lists Shelby Green, Ceo, as its authorized official.

NPPES Registry Identity

NPI1578867982

Entity TypeOrganization

Primary Taxonomy261QM0801X

Legal Business NameRAVENS NEST FOUNDATION INC

Location Address1680 MULKEY RD STE 200Austell, GA 30106-1364

Mailing Address1680 Mulkey Rd Ste 200Austell, GA 30106-1364 · (770) 819-6825 · Fax (770) 819-6826

Phone(770) 819-6825

Fax(770) 819-6826

Organization SubpartNo

Authorized OfficialShelby GreenCeo · (770) 819-6825

Enumeration DateDecember 28, 2010

Last NPPES UpdateJanuary 28, 20263 updates tracked since enumeration

NPPES CertifiedJanuary 28, 2026

✔ NPI 1578867982 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 12

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities

Taxonomy Code261QM0801X

Also ListedCounselorTaxonomy 101Y00000X

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X

Also ListedSocial WorkerTaxonomy 104100000X

Also ListedContractorTaxonomy 171W00000X

Also ListedSpecialistTaxonomy 174400000X

Also ListedPsychiatry & Neurology · Child & Adolescent PsychiatryTaxonomy 2084P0804X

Also ListedCase ManagementTaxonomy 251B00000X

Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X

Also ListedClinic/Center · Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy 261QR0401X

Also ListedSubstance Abuse Rehabilitation FacilityTaxonomy 324500000X

Also ListedSubstance Abuse Rehabilitation Facility · Substance Abuse Treatment, ChildrenTaxonomy 3245S0500X

1680 MULKEY RD STE 200, Austell, GA 30106

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Other Identifiers 1

Medicaid003261381AGA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Ravens Nest Foundation Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Ravens Nest Foundation Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Martin Johnson, M.D.

Psychiatry

NPI 1760784839

3330 CUMBERLAND BLVD SE STE 500
Atlanta, GA 30339

(678) 638-6610

✔ PECOS✔ Accepts Medicare8.4 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2156443

Ravens Nest Foundation, Inc · Austell, GA

Expired · Oct 17, 2026

CLIA Number11D2156443

Laboratory TypePhysician Office

Certificate Effective DateOctober 18, 2024

Certificate Expiration DateOctober 17, 2026

Laboratory DirectorDr. Angela Shannon

Laboratory Phone(770) 819-6825

Laboratory LocationRavens Nest Foundation, Inc3875 Austell Road, Suite 303, Austell, GA 30106

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ravens Nest Foundation Inc's NPI number?

The NPI number for Ravens Nest Foundation Inc is 1578867982. It was assigned to this organization in the NPPES registry on December 28, 2010.

Where is Ravens Nest Foundation Inc located?

Ravens Nest Foundation Inc is located at 1680 Mulkey Rd Ste 200, Austell, GA 30106. The listed phone number is (770) 819-6825.

What is Ravens Nest Foundation Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Is Ravens Nest Foundation Inc enrolled in Medicare?

Yes. Ravens Nest Foundation Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Ravens Nest Foundation Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Psychiatry) reassigns their Medicare billing to Ravens Nest Foundation Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Ravens Nest Foundation Inc accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Ravens Nest Foundation Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ravens Nest Foundation Inc was last updated on January 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.