NPIMap

Organization Active NPI

McIntosh Trail CSB

Doing business as Butts Co DD Center

  • Community/Behavioral Health Agency
  • Jackson, GA
National Provider Identifier
1194993030
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MCINTOSH TRAIL CSB
Doing business as
Butts Co DD Center
Practice address
415 Ernest Biles Dr
Jackson, GA 30233-2282
Phone
(770) 775-5129
NPI assigned
Feb 13, 2008
Last updated
Feb 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

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

Authorized official

Name
Pamela McCollum
Title
Executive Director
Phone
(770) 358-8251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

415 Ernest Biles Dr
Jackson, GA 30233-2282

Mailing address

1501A Kalamazoo Dr
PO Box 1320
Griffin, GA 30224-3919
Phone (770) 358-8250

Other names 1

  • Butts Co DD Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
McIntosh Trail CSB29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

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

View all 28

Locations

415 Ernest Biles Dr
Jackson, GA 30233
Phone (770) 775-5129

NPI Registry JSON

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

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1194993030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501A KALAMAZOO DR",
            "address_2": "PO BOX 1320",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302243919",
            "telephone_number": "770-358-8250",
            "fax_number": "770-229-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 ERNEST BILES DR",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302332282",
            "telephone_number": "770-775-5129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCINTOSH TRAIL CSB",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "MCCOLLUM",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "770-358-8251"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Butts Co DD Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; 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.