1124085451 NPI number — EASTER SEALS SOUTHERN GEORGIA INC.

Table of content: (NPI 1124085451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124085451 NPI number — EASTER SEALS SOUTHERN GEORGIA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS SOUTHERN GEORGIA INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124085451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1906 PALMYRA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31701-1575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-439-7061
Provider Business Mailing Address Fax Number:
229-439-2824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 PALMYRA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31701-1575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-439-7061
Provider Business Practice Location Address Fax Number:
229-439-2824
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HATCHER
Authorized Official First Name:
MATT
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
229-439-7061

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  047-R-0011 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 047-R-0011 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 047-R-0011 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385HR2060X , with the licence number: 047-R-011 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000551405AW , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BG , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BN , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000693844O , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405AZ , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BA , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BM , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000693844C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405AK , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405AX , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BB , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BE , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BL , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BO , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405AY , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000693844N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000693844W , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405BC , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000551405D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000639844T , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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