Predestined for Greatness

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

CCI001578 Issued in GA

Legal business name

PREDESTINED FOR GREATNESS

Practice address

4865 Brookstone Pkwy
Ellenwood, GA 30294-2126

Phone

(770) 320-9278

NPI assigned

May 15, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Dion Thomas

Title

Ceo

Phone

(770) 320-9278

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154537181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4865 BROOKSTONE PKWY",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942126",
            "telephone_number": "770-320-9278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4865 BROOKSTONE PKWY",
            "city": "ELLENWOOD",
            "state": "GA",
            "postal_code": "302942126",
            "telephone_number": "770-320-9278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREDESTINED FOR GREATNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "DION",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-320-9278",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "GA",
            "license": "CCI001578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aliyah Pickering
• Platinum Diagnostic Solutions LLC
• Rasha Kamil Portis, LCSW
• Positive Reinforcement Incorporated
• Powerstix Phlebotomy Co LLC
• Premier Healthcare Providers, LLC
• Prestige Therapeutic Counseling LLC
• Prestige Urgent Care Center
• Pro Staff Medical, LLC
• Progressing Forward ABA Center LLC

• Emotionally Disturbed Childrens' Residential Treatment Facility in Ellenwood, GA
• Providers in Ellenwood, GA by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Georgia

• 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.