# GEORGIA DEPARTMENT OF HUMAN RESOURCES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** East Central Developmental System
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699837864
- **Authorized official:** DR. GAIL C JACKSON M.D. (REGIONAL HOSPITAL ADMINISTRATOR)
- **Authorized official phone:** (706) 790-2030

## Contact information

- **Practice address:** 100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
- **Practice address phone:** (706) 790-2030
- **Mailing address:** 100 MYRTLE BLVD, GRACEWOOD, GA 30812-1500
- **Mailing address phone:** (706) 790-2030

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 315P00000X | Intellectual Disabilities Intermediate Care Facility | 21211622 | GA | Yes |

## Other

- **Enumeration date:** 12/14/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00869206A | — | GA |