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Organization
GEORGIA DEPARTMENT OF HUMAN RESOURCES
Active
Organization
GEORGIA DEPARTMENT OF HUMAN RESOURCES
Active
Other names
East Central Developmental System
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAIL C JACKSON M.D. (REGIONAL HOSPITAL ADMINISTRATOR)
(706) 790-2030
Entity
Organization
Contact information
Practice address
100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
(706) 790-2030
Mailing address
100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
(706) 790-2030
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
21211622
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00869206A
—
GA
Enumeration date
12/14/2006
Last updated
08/22/2020
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