NPIMap

Organization Active NPI

Sumter Youth Develpment Campus

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Americus, GA
National Provider Identifier
1700214574
Registry record updated Oct 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
RN125194 Issued in GA
Legal business name
SUMTER YOUTH DEVELPMENT CAMPUS
Practice address
300 McMath Mill Rd
Americus, GA 31719-8669
Phone
(229) 931-5800
NPI assigned
Oct 14, 2013
Organization subpart
Yes
Parent organization
GEORGIA DEPARTMENT OF JUVENILE JUSTICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2013

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

Authorized official

Name
Mrs. Michelle Staples Horne, M.D.
Title
Director Health Services
Phone
(404) 508-6681

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X RN125194 GA Primary

Addresses

Primary practice location

300 McMath Mill Rd
Americus, GA 31719-8669

Mailing address

300 McMath Mill Road
Americus, GA 31714-8669
Phone (229) 931-5800

National Provider Directory

National Provider Directory
Tax ID family
Ga Department of Juvenile Justice2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

300 McMath Mill Rd
Americus, GA 31719
Phone (229) 894-1618

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1381708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381708800000",
    "number": "1700214574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MCMATH MILL ROAD",
            "city": "AMERICUS",
            "state": "GA",
            "postal_code": "317148669",
            "telephone_number": "229-931-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MCMATH MILL RD",
            "city": "AMERICUS",
            "state": "GA",
            "postal_code": "317198669",
            "telephone_number": "229-931-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMTER YOUTH DEVELPMENT CAMPUS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GEORGIA DEPARTMENT OF JUVENILE JUSTICE",
        "enumeration_date": "2013-10-14",
        "last_updated": "2013-10-14",
        "status": "A",
        "authorized_official_last_name": "STAPLES HORNE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR HEALTH SERVICES",
        "authorized_official_telephone_number": "404-508-6681",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "GA",
            "license": "RN125194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Americus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2013; 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.