Greater Etowah Mental Retardation 310 Board, Inc.

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

GREATER ETOWAH MENTAL RETARDATION 310 BOARD, INC.

Practice address

319 Padenreich Ave
Gadsden, AL 35903-2440

Phone

(256) 546-6016

Fax

(256) 546-6016

NPI assigned

Oct 23, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Barbara S. Clackum

Title

Executive Director

Phone

(256) 546-6016

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144303223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 PADENREICH AVE",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359032440",
            "telephone_number": "256-546-6016",
            "fax_number": "256-546-6016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 PADENREICH AVE",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359032440",
            "telephone_number": "256-546-6016",
            "fax_number": "256-546-6016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER ETOWAH MENTAL RETARDATION 310 BOARD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLACKUM",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "256-546-6016",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy M Gorecki Kelley, CRNP
• Brooke Leann Gorham, D.P.M.
• Billy Barrett Gravitt, DMD
• Cody Barry Gray, CRNP
• Mallory Gray, RPT
• Bradley Stephen Green, M.D.
• Brandi Suzanne Green, OTR/L
• Lisa Dobbins Green, CRNA
• Megan Green, BCBA
• Susan K Green, RPH

• Case Management Agency in Gadsden, AL
• Providers in Gadsden, AL by specialty
• Case Management Agency in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.