NPIMap

Organization Active NPI

South Georgia CSB

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Valdosta, GA
National Provider Identifier
1578636817
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
SOUTH GEORGIA CSB
Practice address
4401 Willow Wood Gate
Valdosta, GA 31602-6709
Phone
(229) 242-4734
Fax
(229) 242-2984
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Sue Gupton
Title
Chief Executive Officer
Phone
(229) 245-2379

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

4401 Willow Wood Gate
Valdosta, GA 31602-6709

Mailing address

4401 Willow Wood Gate
Valdosta, GA 31602-6709
Phone (229) 242-4734

Other names 1

  • Northpoint Doing business as

National Provider Directory

National Provider Directory
Tax ID family
South Ga Community SVS BRD29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578636817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 WILLOW WOOD GATE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026709",
            "telephone_number": "229-242-4734",
            "fax_number": "229-242-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 WILLOW WOOD GATE",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316026709",
            "telephone_number": "229-242-4734",
            "fax_number": "229-242-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH GEORGIA CSB",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GUPTON",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "229-245-2379",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northpoint",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Valdosta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.