NPIMap

Organization Active NPI

McIntosh Trail CSB

  • Community/Behavioral Health Agency
  • McDonough, GA
National Provider Identifier
1801064746
Registry record updated Dec 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
MCINTOSH TRAIL CSB
Practice address
672 Industrial Blvd
McDonough, GA 30253-6611
Phone
(770) 358-8258
Fax
(770) 229-3223
NPI assigned
Feb 13, 2008
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mike Hubbard, LCSW
Title
Ceo
Phone
(770) 358-8251

Corporate family (same tax ID) 28

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

View all 28

National Provider Directory

National Provider Directory
Tax ID family
McIntosh Trail CSB (29 organizations share this tax ID)

Locations

672 Industrial Blvd
McDonough, GA 30253
Phone (770) 358-8258

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

Primary practice location

672 Industrial Blvd
McDonough, GA 30253-6611

Mailing address

1435 N Expressway
Suite 301
Griffin, GA 30223-9016
Phone (770) 358-8250

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
000603435NMedicaidGA
000603435FMedicaidGA

Other names 1

NPPES NPI Registry
  • Henry DD Service Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 17, 2015.

{
    "created_epoch": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450310400000",
    "number": "1801064746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 N EXPRESSWAY",
            "address_2": "SUITE 301",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302239016",
            "telephone_number": "770-358-8250",
            "fax_number": "770-229-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "672 INDUSTRIAL BLVD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302536611",
            "telephone_number": "770-358-8258",
            "fax_number": "770-229-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCINTOSH TRAIL CSB",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2015-12-17",
        "status": "A",
        "authorized_official_last_name": "HUBBARD",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-358-8251",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000603435N",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000603435F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry DD Service Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in McDonough, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; 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.