Autumn's Harbor, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

AUTUMN'S HARBOR, LLC

Practice address

601 N Belair SQ Ste 2
Evans, GA 30809-4322

Phone

(706) 750-8329

NPI assigned

Jan 26, 2022

Last updated

Sep 19, 2022By 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

John Butler Martin, LCSWNPI 1780241570

Title

Owner

Phone

(912) 531-3404

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• John Butler Martin, LCSW, MAC

  • Clinical Social Worker
  • Evans, GA
  • NPI 1780241570
  Authorized official Same address or phone

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663545600000",
    "number": "1972255404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 N BELAIR SQ STE 2",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094322",
            "telephone_number": "706-750-8329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N BELAIR SQ STE 2",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094322",
            "telephone_number": "706-750-8329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN'S HARBOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-09-19",
        "certification_date": "2022-09-19",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "BUTLER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-531-3404",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Evans, GA
• Providers in Evans, 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 Sep 19, 2022; 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.