Outpatient Detox Center of Georgia LLC

Primary specialty

Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X

Legal business name

OUTPATIENT DETOX CENTER OF GEORGIA LLC

Practice address

2340 Wood Creek CT
Dacula, GA 30019-3170

Phone

(470) 642-6210

NPI assigned

Jun 27, 2023

Last updated

Jun 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Zandria HamiltonNPI 1740817709

Title

President

Phone

(470) 642-6210

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Zandria Hamilton

  • Family Medicine Physician
  • Grayson, GA
  • NPI 1740817709
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1687824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1497431118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2340 WOOD CREEK CT",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300193170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 WOOD CREEK CT",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300193170",
            "telephone_number": "470-642-6210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTPATIENT DETOX CENTER OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-27",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A",
        "authorized_official_last_name": "HAMILTON",
        "authorized_official_first_name": "ZANDRIA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "470-642-6210"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Comprehensive Outpatient Rehabilitation Facility (CORF) in Dacula, GA
• Providers in Dacula, GA by specialty
• Comprehensive Outpatient Rehabilitation Facility (CORF) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.