Devereux Foundation

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

DEVEREUX FOUNDATION

Practice address

1283 Kennestone Cir
Suite 100
Marietta, GA 30066-6029

Phone

(678) 303-2705

NPI assigned

Nov 30, 2007

Last updated

Nov 30, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mario Bolivar Jr.

Title

Executive Director

Phone

(687) 303-2669

Specialties & licenses 1

Addresses

Other names 1

• Devereux Georgia Treatment Network Other name

Tax ID family

Comm SVCS of Devereux332 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 2

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

• Devereux Foundation

  • Psychiatric Residential Treatment Facility
  • Kennesaw, GA
  • NPI 1346319142
  NPD tax ID
• Devereux Georgia

  • Psychiatric Residential Treatment Facility
  • Kennesaw, GA
  • NPI 1073997888
  NPD tax ID

Locations

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1720260862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1283 KENNESTONE CIR",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666029",
            "telephone_number": "678-303-2705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1283 KENNESTONE CIR",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666029",
            "telephone_number": "678-303-2705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEVEREUX FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "BOLIVAR",
        "authorized_official_first_name": "MARIO",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "687-303-2669",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Devereux Georgia Treatment Network",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Julie Desir
• Vanessa Desir
• Amy Desrochers, RN
• Wanda Hazel Devaughn, LCSW
• Danette M Dever, M.ED., LPC
• Gayathri K Devineni, MD
• Indira Devu, MD
• Jacob Daniel Deweese, OD
• Susan Ulmer Dewolf, CRNFA, NP-C
• Mary Curran Dewyngaert, PA-AA

• Community/Behavioral Health Agency in Marietta, GA
• Providers in Marietta, GA by specialty
• Community/Behavioral Health Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; 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.