NPIMap

Organization Active NPI

Icfmr at Georgia Regional Hospital Atlanta

  • Intellectual Disabilities Intermediate Care Facility
  • Decatur, GA
National Provider Identifier
1841328135
Registry record updated Aug 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2044856 Issued in GA
Legal business name
ICFMR AT GEORGIA REGIONAL HOSPITAL ATLANTA
Practice address
3073 Panthersville Road
Decatur, GA 30034-3828
Phone
(404) 243-2158
Fax
(404) 243-2159
NPI assigned
Mar 1, 2007
Last updated
Aug 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2009

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

Authorized official

Name
Sonny Slate, COO
Title
Chief Operation Officer
Phone
(404) 243-2121

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X
Intellectual Disabilities Intermediate Care Facility 315P00000X 2044856 GA Primary

Addresses

Primary practice location

3073 Panthersville Road
Decatur, GA 30034-3828

Mailing address

P.O. Box 370407
Decatur, GA 30034-3828
Phone (404) 243-2158

Other identifiers 1

IdentifierTypeStateIssuer
00141061AMedicaidGA

National Provider Directory

National Provider Directory
Tax ID family
Department of Behavioral Health Developmental Disabilities Ga53 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

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

View all 24

Locations

3073 Panthersville Rd
Decatur, GA 30034
Phone (404) 243-2100

Practitioners & affiliated clinicians

Practitioners 4

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": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250553600000",
    "number": "1841328135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 370407",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300343828",
            "telephone_number": "404-243-2158",
            "fax_number": "404-243-2159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3073 PANTHERSVILLE ROAD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300343828",
            "telephone_number": "404-243-2158",
            "fax_number": "404-243-2159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICFMR AT GEORGIA REGIONAL HOSPITAL ATLANTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2009-08-18",
        "status": "A",
        "authorized_official_last_name": "SLATE",
        "authorized_official_first_name": "SONNY",
        "authorized_official_title_or_position": "CHIEF OPERATION OFFICER",
        "authorized_official_telephone_number": "404-243-2121",
        "authorized_official_credential": "COO"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "GA",
            "license": "2044856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00141061A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; 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.