Kelly Town Family Group

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

20100006464 Issued in AL

Legal business name

KELLY TOWN FAMILY GROUP

Practice address

618 Medway Drive
McDonough, GA 30253

Phone

(678) 353-4677

NPI assigned

Oct 19, 2010

Organization subpart

No

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

Authorized official

Name

Ms. Terrie Peters

Title

Owner

Phone

(678) 353-4677

Specialties & licenses 1

Addresses

Other names 1

• Health Care connect group Other name

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287446400000",
    "number": "1114237567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 MEDWAY DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302524155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 MEDWAY DRIVE",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "30253",
            "telephone_number": "678-353-4677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY TOWN FAMILY GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-19",
        "last_updated": "2010-10-19",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "TERRIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-353-4677",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AL",
            "license": "20100006464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Health Care connect group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in McDonough, GA
• Providers in McDonough, GA by specialty
• Mental Illness Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2010; 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.