Active NPI
Southern Health Corp of Ellijay
- Skilled Nursing Facility
- Ellijay, GA
National Provider Identifier
1902963580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1-061-1232
- Legal business name
- SOUTHERN HEALTH CORP OF ELLIJAY
- Practice address
- 1362 S Main St
Ellijay, GA 30540-5410 - Phone
- (706) 276-4741
- Fax
- (706) 276-4745
- NPI assigned
- Jan 2, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jeffrey M Dunn, CEO
- Title
- Chief Executive Officer
- Phone
- (706) 276-4741
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 1-061-1232 | GA | |
| Skilled Nursing Facility | 314000000X | 1-061-1232 | GA | Primary |
Addresses
Primary practice location
1362 S Main St
Ellijay, GA 30540-5410
Mailing address
PO Box 1161
Ellijay, GA 30540-0015
Phone (706) 276-4741
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00141127A | Medicaid | GA | |
| 501001 | Other | GA | BLUE CROSS |
Other names 1
- GILMER NURSING HOME
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1200528000000",
"number": "1902963580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1161",
"city": "ELLIJAY",
"state": "GA",
"postal_code": "305400015",
"telephone_number": "706-276-4741",
"fax_number": "706-276-4745"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1362 S MAIN ST",
"city": "ELLIJAY",
"state": "GA",
"postal_code": "305405410",
"telephone_number": "706-276-4741",
"fax_number": "706-276-4745"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHERN HEALTH CORP OF ELLIJAY",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-02",
"last_updated": "2008-01-17",
"status": "A",
"authorized_official_last_name": "DUNN",
"authorized_official_first_name": "JEFFREY",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "706-276-4741",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "CEO"
},
"taxonomies": [
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "GA",
"license": "1-061-1232",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "GA",
"license": "1-061-1232",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00141127A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "501001",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "GILMER NURSING HOME",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ellijay, GA
- Southern Health Corp of Ellijay
- Southern Health Corp of Ellijay
- Southern Health Corp of Ellijay
- Southern Health Corp of Ellijay
- Southern Health Corp of Ellijay
- Southern Health Corp of Ellijay
- Southland Health Services of Georgia, Inc.
- Linda Jeannette Stanley, LMT
- Donna Greene Sweat, FNP-C
- Talbot Dental Associates PC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.