Ego Ideal, Inc.

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

EGO IDEAL, INC.

Practice address

4484 Covington Hwy
Decatur, GA 30035-1203

Phone

(678) 705-9527

NPI assigned

May 2, 2019

Organization subpart

No

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

Authorized official

Name

Charles L Miller

Title

Cfo

Phone

(678) 705-9527

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1556755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1215592431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3574 COLUMBIA PKWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300343349",
            "telephone_number": "678-705-9527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4484 COVINGTON HWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300351203",
            "telephone_number": "678-705-9527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EGO IDEAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-02",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "678-705-9527"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rodney Edwards, PT, DPT
• Teresa A Edwards, RN
• Thomas Elliot Edwards Jr., M.D.
• Thomas Strother Edwards, MD
• Latise Egeston, LPC
• Maxwell Armand Eidex, MD
• Pamela Sue Eilender, PSY.D.
• Jonathan Eisenstat, M.D.
• Ijeoma Ejigiri, MD
• Badi El Osta, M.D.

• Developmentally Disabled Services Day Training Agency in Decatur, GA
• Providers in Decatur, GA by specialty
• Developmentally Disabled Services Day Training Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; 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.