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NPI Code Detail

MEDICARE: EASTER SEALS WEST GEORGIA, INC

MEDICARE: EASTER SEALS WEST GEORGIA, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2251C00000XDevelopmentally Disabled Services Day Training Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073660528
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTER SEALS WEST GEORGIA, INC
Provider Business Mailing Address
First Line : PO BOX 1690
Second Line :
City : FORTSON
State : GA
Zip : 31808-1690
Country : US
Telephone Number : 706-660-1144
Fax Number :
Provider Business Practice Location Address
First Line : 2515 DOUBLE CHURCHES RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-2742
Country : US
Telephone Number : 706-660-1144
Fax Number :
Authorized Official
Title or Position : FINANCE/ACCOUNTING MANAGER
Name : MRS. CHERYL GREGORY
Credential :
Telephone Number : 706-221-4425
Provider Enumeration Date : 01/05/2007
Last Update Date : 05/15/2024

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