Ga Department of Juvenile Justice

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

GA DEPARTMENT OF JUVENILE JUSTICE

Practice address

3408 Covington Hwy
Decatur, GA 30032-1513

Phone

(404) 508-6610

Fax

(404) 508-5091

NPI assigned

Feb 2, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Sandra Deaton

Title

Federal Programs Director

Phone

(404) 508-6610

Specialties & licenses 2

Addresses

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.

• Sumter Youth Develpment Campus

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Americus, GA
  • NPI 1700214574
  NPD tax ID

Locations

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1700924750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3408 COVINGTON HWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321513",
            "telephone_number": "404-508-6610",
            "fax_number": "404-508-5091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3408 COVINGTON HWY",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321513",
            "telephone_number": "404-508-6610",
            "fax_number": "404-508-5091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GA DEPARTMENT OF JUVENILE JUSTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "DEATON",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "FEDERAL PROGRAMS DIRECTOR",
        "authorized_official_telephone_number": "404-508-6610",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tomeka Bonshell Fuller, LPN
• NA-Ilah Imani Fulton, MA
• Susan McCarthy Furman, PH.D.
• Ga Department of Behavioral Health and Developmental Disabilities
• Ga Department of Human Resources
• Ga Excel Behavioral Health Services
• Ga Resources: Education Advocacy Treatment for Deaf Adults Youth Inc.
• Lena V Gabinskaya, RD, LD
• Catherine Matthews Gable, PHARMD
• Tara Gaddis, LMSW

• Emotionally Disturbed Childrens' Residential Treatment Facility in Decatur, GA
• Providers in Decatur, GA by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.