NPIMap

Organization Active NPI

Kennestone Hosptial, Inc.

  • Psychiatric Hospital
  • Austell, GA
National Provider Identifier
1902877418
Registry record updated Feb 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
033-432 Issued in GA
Legal business name
KENNESTONE HOSPTIAL, INC.
Practice address
3950 Austell Rd
Wellstar Behavioral Health Center
Austell, GA 30106-1121
Phone
(770) 732-6570
Fax
(770) 732-6549
NPI assigned
Feb 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2020

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

Authorized official

Name
Gregory L Simone, MD
Title
President & Ceo
Phone
(770) 792-7600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 033-432 GA Primary

Addresses

Primary practice location

3950 Austell Rd
Wellstar Behavioral Health Center
Austell, GA 30106-1121

Mailing address

2000 S Park PL SE
Windy Hill Exchange Building
Atlanta, GA 30339-2013
Phone (770) 956-6464

Other identifiers 1

IdentifierTypeStateIssuer
00001999AMedicaidGA

Other names 1

  • WellStar Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ross W John7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

2000 S Park Pl SE
Atlanta, GA 30339
Phone (770) 956-6464

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582502400000",
    "number": "1902877418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 S PARK PL SE",
            "address_2": "WINDY HILL EXCHANGE BUILDING",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303392013",
            "telephone_number": "770-956-6464",
            "fax_number": "770-956-6463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD",
            "address_2": "WELLSTAR BEHAVIORAL HEALTH CENTER",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061121",
            "telephone_number": "770-732-6570",
            "fax_number": "770-732-6549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNESTONE HOSPTIAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-01",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A",
        "authorized_official_last_name": "SIMONE",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "770-792-7600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "GA",
            "license": "033-432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00001999A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WellStar Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; 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.