NPIMap

Organization Active NPI

Devereux Goergia Treatment Network

  • Psychiatric Residential Treatment Facility
  • Kennesaw, GA
National Provider Identifier
1619424231
Registry record updated Sep 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Residential Treatment FacilityTaxonomy code 323P00000X
License
0038001 Issued in GA
Legal business name
DEVEREUX GOERGIA TREATMENT NETWORK
Practice address
1291 Stanley Rd
Kennesaw, GA 30152
Phone
(770) 427-0147
NPI assigned
Sep 1, 2016
Last updated
Sep 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2016

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

Authorized official

Name
Dr. Yolanda Patrice Graham, M.D.NPI 1962537159
Title
Medical Director
Phone
(770) 427-0147

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Residential Treatment Facility 323P00000X 0038001 GA Primary

Addresses

Primary practice location

1291 Stanley Rd
Kennesaw, GA 30152

Mailing address

1291 Stanley Rd NW
Kennesaw, GA 30152-4359
Phone (770) 427-0147

National Provider Directory

National Provider Directory
Tax ID family
Youth Villages19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472688000000",
    "number": "1619424231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1291 STANLEY RD NW",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301524359",
            "telephone_number": "770-427-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1291 STANLEY RD",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "30152",
            "telephone_number": "770-427-0147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVEREUX GOERGIA TREATMENT NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-01",
        "last_updated": "2016-09-01",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "YOLANDA",
        "authorized_official_middle_name": "PATRICE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "770-427-0147",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "GA",
            "license": "0038001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennesaw, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2016; 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.