Shirley Home Away From Home

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

056-01-011-1 Issued in GA

Legal business name

SHIRLEY HOME AWAY FROM HOME

Practice address

190 Middling LN
Fayetteville, GA 30214-3767

Phone

(678) 557-2207

NPI assigned

Sep 9, 2009

Organization subpart

No

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

Authorized official

Name

Shirley Wilson

Title

Administrator

Phone

(678) 557-2207

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252454400000",
    "number": "1457684482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 MIDDLING LN",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302143767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 MIDDLING LN",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302143767",
            "telephone_number": "678-557-2207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHIRLEY HOME AWAY FROM HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-09",
        "last_updated": "2009-09-09",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "678-557-2207"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "GA",
            "license": "056-01-011-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "155482054B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Kay Shepard, M.D.
• Anne Marie Sheridan
• Daryl Sherrod, M.D.
• Taiwo Sheyin, MD
• Emily Shiflett
• Shittu Family Practice,LLC
• Myra Shivers
• Ameera Waseem Siddiqi, MD
• Howard J Silk, MD
• Silver Cypress Group, LLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2009; 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.