NPIMap

Organization Active NPI

Georgia Department of Human Resources

Doing business as East Central Developmental System

  • Intellectual Disabilities Intermediate Care Facility
  • Gracewood, GA
National Provider Identifier
1699837864
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
21211622 Issued in GA
Legal business name
GEORGIA DEPARTMENT OF HUMAN RESOURCES
Doing business as
East Central Developmental System
Practice address
100 Myrtle Blvd
Gracewood, GA 30812-1500
Phone
(706) 790-2030
NPI assigned
Dec 14, 2006
Last updated
Aug 22, 2020By the provider in NPPES
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
Dr. Gail C Jackson, M.D.NPI 1417165531
Title
Regional Hospital Administrator
Phone
(706) 790-2030

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
Intellectual Disabilities Intermediate Care Facility 315P00000X 21211622 GA Primary

Addresses

Primary practice location

100 Myrtle Blvd
Gracewood, GA 30812-1500

Mailing address

100 Myrtle Blvd
Gracewood, GA 30812-1500
Phone (706) 790-2030

Other identifiers 1

IdentifierTypeStateIssuer
00869206AMedicaidGA

Other names 1

  • East Central Developmental System Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ga Department of Behavioral Health and Developmental Disabilities74 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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": "1166054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699837864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD",
            "city": "GRACEWOOD",
            "state": "GA",
            "postal_code": "308121500",
            "telephone_number": "706-790-2030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MYRTLE BLVD",
            "city": "GRACEWOOD",
            "state": "GA",
            "postal_code": "308121500",
            "telephone_number": "706-790-2030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DEPARTMENT OF HUMAN RESOURCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "REGIONAL HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "706-790-2030",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "GA",
            "license": "21211622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00869206A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Central Developmental System",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gracewood, 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.