NPIMap

Organization Active NPI

Pathways Center for Behavioral and Developmental Growth

  • Community/Behavioral Health Agency
  • Greenville, GA
National Provider Identifier
1689736647
Registry record updated Feb 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH
Practice address
756 Woodbury Road
Greenville, GA 30222-1514
Phone
(706) 672-1118
Fax
(706) 672-1918
NPI assigned
Dec 15, 2006
Organization subpart
Yes
Parent organization
PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 26, 2013

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

Authorized official

Name
Jade Russell Benefield, MBA
Title
Executive Director
Phone
(706) 845-4045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

756 Woodbury Road
Greenville, GA 30222-1514

Mailing address

122 Gordon Commercial Drive
Suite C
Lagrange, GA 30240-5740
Phone (706) 845-4045

Other identifiers 1

IdentifierTypeStateIssuer
000599332EMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040430000883 GA Part B Supplier - Clinic/Group Practice 5193712073 Receives reassigned benefits from 23 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carrollton, GA; Franklin, GA; Greenville, GA; Griffin, GA; Lagrange, GA; Newnan, GA

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Pathways Center CSB

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361836800000",
    "number": "1689736647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 GORDON COMMERCIAL DRIVE",
            "address_2": "SUITE C",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302405740",
            "telephone_number": "706-845-4045",
            "fax_number": "706-845-4367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "756 WOODBURY ROAD",
            "city": "GREENVILLE",
            "state": "GA",
            "postal_code": "302221514",
            "telephone_number": "706-672-1118",
            "fax_number": "706-672-1918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PATHWAYS CENTER FOR BEHAVIORAL AND DEVELOPMENTAL GROWTH",
        "enumeration_date": "2006-12-15",
        "last_updated": "2013-02-26",
        "status": "A",
        "authorized_official_last_name": "BENEFIELD",
        "authorized_official_first_name": "JADE",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "706-845-4045",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000599332E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2013; 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.