NPIMap

Organization Active NPI

Parkside Homes

  • Custodial Care Facility
  • Moultrie, GA
National Provider Identifier
1457783094
Registry record updated Aug 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Custodial Care FacilityTaxonomy code 311Z00000X
Legal business name
PARKSIDE HOMES
Practice address
119 4TH St SW
Moultrie, GA 31768-4547
Phone
(229) 798-0170
NPI assigned
Aug 6, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2013

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

Authorized official

Name
Mr. Wayland Smith Smith, RN
Title
Owner
Phone
(229) 798-0170

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Custodial Care Facility 311Z00000X Primary

Addresses

Primary practice location

119 4TH St SW
Moultrie, GA 31768-4547

Mailing address

PO Box 2132
Moultrie, GA 31776-2132
Phone (229) 798-0170

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1375747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375747200000",
    "number": "1457783094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2132",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317762132",
            "telephone_number": "229-798-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 4TH ST SW",
            "city": "MOULTRIE",
            "state": "GA",
            "postal_code": "317684547",
            "telephone_number": "229-798-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-06",
        "last_updated": "2013-08-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "WAYLAND SMITH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-798-0170",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moultrie, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2013; 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.