NPIMap

Organization Active NPI

Southern Health Corp of Ellijay

Doing business as Parkside Ellijay

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Ellijay, GA
National Provider Identifier
1083144109
Registry record updated Jun 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
SOUTHERN HEALTH CORP OF ELLIJAY
Doing business as
Parkside Ellijay
Practice address
1362 S Main St
Ellijay, GA 30540-5410
Phone
(706) 635-7881
Fax
(706) 276-3698
NPI assigned
Jun 13, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2017

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

Authorized official

Name
Ms. Sheila Brockman
Title
Chief Executive Officer
Phone
(706) 635-7881

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary

Addresses

Primary practice location

1362 S Main St
Ellijay, GA 30540-5410

Mailing address

PO Box 2239
Ellijay, GA 30540-0025
Phone (706) 635-7881

Other names 1

  • Parkside Ellijay Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southern Heatlh Corp DB6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1497312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497312000000",
    "number": "1083144109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2239",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305400025",
            "telephone_number": "706-635-7881",
            "fax_number": "706-276-3698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1362 S MAIN ST",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305405410",
            "telephone_number": "706-635-7881",
            "fax_number": "706-276-3698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HEALTH CORP OF ELLIJAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-13",
        "last_updated": "2017-06-13",
        "status": "A",
        "authorized_official_last_name": "BROCKMAN",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "706-635-7881",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkside Ellijay",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Parkside Ellijay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.