NPIMap

Organization Active NPI

Douglas County Community Services Board

  • Community/Behavioral Health Agency
  • Douglasville, GA
National Provider Identifier
1720128879
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
DOUGLAS COUNTY COMMUNITY SERVICES BOARD
Practice address
5274 Big a Rd
Douglasville, GA 30135-5308
Phone
(770) 920-0717
NPI assigned
Feb 7, 2007
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
Tod Citron
Title
Ceo
Phone
(770) 429-5000

Specialties & licenses 1

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

Addresses

Primary practice location

5274 Big a Rd
Douglasville, GA 30135-5308

Mailing address

3830 S Cobb Dr SE
Suite 300
Smyrna, GA 30080-5532
Phone (770) 429-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191206001032 GA Part B Supplier - Clinic/Group Practice 0143653014 Receives reassigned benefits from 5 practitioners
Practice locations: Douglasville, GA

National Provider Directory

National Provider Directory
Tax ID family
Douglas Community Services Board8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

5905 Stewart Pkwy
Douglasville, GA 30135
Phone (470) 893-0763

Practitioners & affiliated clinicians

Practitioners 8

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": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720128879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 S COBB DR SE",
            "address_2": "SUITE 300",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300805532",
            "telephone_number": "770-429-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5274 BIG A RD",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301355308",
            "telephone_number": "770-920-0717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS COUNTY COMMUNITY SERVICES BOARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CITRON",
        "authorized_official_first_name": "TOD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-429-5000"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, 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.
  • 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.