NPIMap

Organization Active NPI

Collective Communities Incorporated

  • Developmentally Disabled Services Day Training Agency
  • Jonesboro, GA
National Provider Identifier
1376241471
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X
Legal business name
COLLECTIVE COMMUNITIES INCORPORATED
Practice address
217 Arrowhead Blvd Unit 81
Jonesboro, GA 30236-1169
Phone
(770) 648-5293
NPI assigned
Feb 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

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

Authorized official

Name
Mrs. Shawndra Jovan EcholsNPI 1558607192
Title
Managing Director
Phone
(770) 648-5293

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmentally Disabled Services Day Training Agency 251C00000X Primary

Addresses

Primary practice location

217 Arrowhead Blvd Unit 81
Jonesboro, GA 30236-1169

Mailing address

110 Walter Way Unit 1562
Stockbridge, GA 30281-9515
Phone (678) 756-1772

Other identifiers 3

IdentifierTypeStateIssuer
003231691AMedicaidGA
003227996BMedicaidGA
003227996AMedicaidGA

National Provider Directory

National Provider Directory

Locations

217 Arrowhead Blvd
Unit 81
Jonesboro, GA 30236
Phone (770) 648-5293

110 Walter Way
Unit 1562
Stockbridge, GA 30281

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1376241471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 WALTER WAY UNIT 1562",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302819515",
            "telephone_number": "678-756-1772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 ARROWHEAD BLVD UNIT 81",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302361169",
            "telephone_number": "770-648-5293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLECTIVE COMMUNITIES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A",
        "authorized_official_last_name": "ECHOLS",
        "authorized_official_first_name": "SHAWNDRA",
        "authorized_official_middle_name": "JOVAN",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "770-648-5293",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003231691A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003227996B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003227996A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; 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.