Organization Active NPI

Easter Seals Southern Georgia Inc.

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Albany, GA

National Provider Identifier

1124085451

Registry record updated Jan 24, 2021

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Albany, GA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License: 047-R-0011 Issued in GA
Legal business name: EASTER SEALS SOUTHERN GEORGIA INC.
Practice address: 1906 Palmyra Rd
Albany, GA 31701-1575
Phone: (229) 439-7061
Fax: (229) 439-2824
NPI assigned: Apr 28, 2006
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Jan 24, 2021

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

Authorized official

Name: Matt Hatcher
Title: Coo
Phone: (229) 439-7061

Specialties & licenses 4

Specialty (taxonomy)	Code	License	State	Primary
Developmentally Disabled Services Day Training Agency	251C00000X	047-R-0011	GA
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	320900000X	047-R-0011	GA	Primary
Durable Medical Equipment & Medical Supplies	332B00000X	047-R-0011	GA
Child Intellectual and/or Developmental Disabilities Respite Care	385HR2060X	047-R-011	GA

Addresses

Primary practice location

1906 Palmyra Rd
Albany, GA 31701-1575

Mailing address

1906 Palmyra Rd
Albany, GA 31701-1575
Phone (229) 439-7061

Other identifiers 33

Identifier	Type	State
000551405AW	Medicaid	GA
000551405BG	Medicaid	GA
000551405BN	Medicaid	GA
000693844O	Medicaid	GA
000551405AZ	Medicaid	GA
000551405BA	Medicaid	GA
000551405BM	Medicaid	GA
000693844C	Medicaid	GA
000551405AK	Medicaid	GA
000551405AX	Medicaid	GA
000551405BB	Medicaid	GA
000551405BE	Medicaid	GA
000551405BL	Medicaid	GA
000551405BO	Medicaid	GA
000551405AY	Medicaid	GA
000693844N	Medicaid	GA
000693844W	Medicaid	GA
000551405BC	Medicaid	GA
000551405D	Medicaid	GA
000639844T	Medicaid	GA
000693844V	Medicaid	GA
000551405A	Medicaid	GA
000551405F	Medicaid	GA
000551405J	Medicaid	GA
000693844Q	Medicaid	GA
000551405BF	Medicaid	GA
000551405BH	Medicaid	GA
000693844S	Medicaid	GA
000693844X	Medicaid	GA
000520528A	Medicaid	GA
000551405AI	Medicaid	GA
000551405BI	Medicaid	GA
000693844B	Medicaid	GA

National Provider Directory

Tax ID family: Easter Seals Southern Georgia Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Easter Seals Southern Georgia Inc.
- Developmentally Disabled Services Day Training Agency
- Albany, GA
- NPI 1295017325
NPD tax ID

Locations

1906 Palmyra Rd
Albany, GA 31701
Phone (229) 439-7061

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611446400000",
    "number": "1124085451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 PALMYRA RD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011575",
            "telephone_number": "229-439-7061",
            "fax_number": "229-439-2824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
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            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011575",
            "telephone_number": "229-439-7061",
            "fax_number": "229-439-2824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTER SEALS SOUTHERN GEORGIA INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-28",
        "last_updated": "2021-01-24",
        "certification_date": "2021-01-24",
        "status": "A",
        "authorized_official_last_name": "HATCHER",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "229-439-7061"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "GA",
            "license": "047-R-0011",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
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            "state": "GA",
            "license": "047-R-0011",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "047-R-0011",
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": "GA",
            "license": "047-R-011",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
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        },
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            "code": "05",
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            "state": "GA"
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            "code": "05",
            "desc": "MEDICAID",
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            "identifier": "000693844B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2021; 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.