ICFMR AT GEORGIA REGIONAL HOSPITAL ATLANTA (NPI# 1841328135) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841328135 |
| Entity Type | Organization |
| Organization Name | ICFMR AT GEORGIA REGIONAL HOSPITAL ATLANTA |
| Practice Address |
3073 Panthersville Road Decatur GA 30034-3828 |
| Mailing Address |
P.o. Box 370407 Decatur GA 30034-3828 |
| Practice Telephone | 4042432158 |
| Practice Fax Number | 4042432159 |
| Mailing Telephone | 4042432158 |
| Mailing Fax Number | 4042432159 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2009-08-18 |
| Authorized Official Name | SONNY SLATE (CHIEF OPERATION OFFICER) |
| Authorized Official Telephone | 4042432121 |
| Authorized Official Credential | COO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities | ||
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 2044856 | GA | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00141061A | 05 |
| Street Address |
3073 PANTHERSVILLE ROAD |
| City | DECATUR |
| State | GA |
| Zip Code | 30034-3828 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922056902 | Delquis Rafael Mendoza | Psychiatry & Neurology | 3073 Panthersville Road, Patients Accounts Office, Decatur, GA 30034 | 2006-05-04 |
| 1497035380 | Dene Ruth Bellamy | Clinical Nurse Specialist | 3073 Panthersville Road, Decatur, GA 30034 | 2011-08-23 |
| 1821287046 | Katina M New | Nurse Practitioner | 3073 Panthersville Road, Medical Clinic, Decatur, GA 30034-3828 | 2007-10-24 |
| 1730378951 | Steven C Stout | Psychiatry & Neurology | 3073 Panthersville Road, Patient Accounts, Decatur, GA 30034-3828 | 2007-10-24 |
| 1942320031 | Verona D Lawson | Psychiatry & Neurology | 3073 Panthersville Road, Patient Accounts Office, Decatur, GA 30034-3828 | 2007-03-30 |
| 1881728749 | Georgia Regional Hospital Pharmacy | Pharmacy | 3073 Panthersville Road, Patient Accounts Office, Decatur, GA 30034-3828 | 2007-03-15 |
| 1659409951 | Skilled Nursing Facility Grha | Skilled Nursing Facility | 3073 Panthersville Road, Decatur, GA 30034-3828 | 2007-03-01 |
| 1659314847 | Donald W Smith | Psychologist | 3073 Panthersville Road, Decatur, GA 30034-3828 | 2006-06-14 |
| 1730122482 | Ga Department of Human Resources | Psychiatric Hospital | 3073 Panthersville Road, Decatur, GA 30034-3828 | 2006-06-13 |
| 1598713448 | Scott John Schoenherr | Psychologist | 3073 Panthersville Road, Patient Accounts Office, Decatur, GA 30034-3828 | 2006-05-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689289803 | Kalesha Uneek Presswood | Behavior Technician | 5361 Roswell Rd, Atlanta, GA 30034 | 2020-09-14 |
| 1447876768 | Rosemary Maines | Recreation Therapist | The Maines Group LLC Dba Maines Health and Wellness, 3461 Jessica Run, Decatur, GA 30034 | 2020-06-23 |
| 1437775764 | The Maines Group, LLC | Adult Companion | The Maines Group, LLC Dba Maines Health and Wellness, 3461 Jessica Run, Decatur, GA 30034 | 2020-06-23 |
| 1801351994 | Anthony E. Parrish, D.d.s., PC | Dentist | 3653 Flakes Mill Road, Suite E, Deactur, GA 30034 | 2019-02-04 |
| 1164916813 | Lenina O Chi-ukpai | Nurse Practitioner | 2942 Secretariat Ct, Decatur, GA 30034 | 2018-06-17 |
| 1154662765 | Zackery Kanel Thomas | Driver | 2782 Green Marsh Court, Decatur, GA 30034 | 2013-03-06 |
| 1033472642 | Lakeba Hibbler Williams | Counselor | 4147 Flat Shoals Pkwy, Decatur, GA 30034 | 2012-06-19 |
| 1164789632 | Foot Solutions of Georgia | Durable Medical Equipment & Medical Supplies | 3011 S Rainbow Dr, Suite 160, Decatur, GA 30034 | 2012-04-20 |
| 1699096172 | Wanda P Garrett | Social Worker | 3013 Rainbow Drive, Suite 112-e, South Dekalb Office Park, Decatur, GA 30034 | 2010-06-18 |
| 1245558022 | Teresa Behrend Fletcher | Counselor | 3915 Brookside Pkwy, Decatur, GA 30034 | 2010-05-04 |
| Find all providers in zip 30034 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326392432 | Extending Community Services Foundation | Intermediate Care Facility, Mentally Retarded | 3630 Emerald Pt, Decatur, GA 30034-5739 | 2012-10-29 |
| 1427336346 | Tranquility PCh, LLC | Intermediate Care Facility, Mentally Retarded | 3440 Rainbow Dr, Decatur, GA 30034-1807 | 2011-07-26 |
| 1336362300 | J & J Maupin Group Homes Inc. | Intermediate Care Facility, Mentally Retarded | 5310 E William Street Rd, Decatur, IL 62521-1874 | 2007-04-10 |
| 1487788311 | Alpha Omega Consulting, Inc. | Intermediate Care Facility, Mentally Retarded | 729 S Webster St, Decatur, IL 62521-2672 | 2007-03-15 |
| 1295869121 | Alpha Omega Consulting, Inc. | Intermediate Care Facility, Mentally Retarded | 3850 E Fulton Ave, Decatur, IL 62521-5088 | 2007-03-15 |
| 1851424998 | Alpha Omega Consulting, Inc. | Intermediate Care Facility, Mentally Retarded | 805 E Johns Ave, Decatur, IL 62521-2681 | 2007-03-14 |
| 1902936420 | Autumn Leaves, Inc. | Intermediate Care Facility, Mentally Retarded | 1479 S 44th St, Decatur, IL 62521-4323 | 2007-03-06 |
| 1306975594 | Autumn Leaves, Inc. | Intermediate Care Facility, Mentally Retarded | 4838 Beacon Street, Decatur, IL 62521 | 2007-03-05 |
| 1891824892 | Autumn Leaves, Inc. | Intermediate Care Facility, Mentally Retarded | 3905 E. Hickory St., Decatur, IL 62521 | 2007-03-05 |
| 1740404896 | J & J Maupin Group Homes Inc. | Intermediate Care Facility, Mentally Retarded | 5310 E William Street Rd, Decatur, IL 62521-1874 | 2007-04-12 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.