Organization
EASTER SEALS SOUTHERN GEORGIA INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT HATCHER (COO)
(229) 439-7061
Entity
Organization
Contact information
Practice address
1906 PALMYRA RD, ALBANY, GA 31701-1575
(229) 439-7061
(229) 439-2824
Mailing address
1906 PALMYRA RD, ALBANY, GA 31701-1575
(229) 439-7061
(229) 439-2824
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
047-R-0011
GA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
047-R-0011
GA
332B00000X
Durable Medical Equipment & Medical Supplies
047-R-0011
GA
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
047-R-011
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000520528A
—
GA
05
—
000551405A
—
GA
05
—
000551405AI
—
GA
05
—
000551405AK
—
GA
05
—
000551405AW
—
GA
05
—
000551405AX
—
GA
05
—
000551405AY
—
GA
05
—
000551405AZ
—
GA
05
—
000551405BA
—
GA
05
—
000551405BB
—
GA
05
—
000551405BC
—
GA
05
—
000551405BE
—
GA
05
—
000551405BF
—
GA
05
—
000551405BG
—
GA
05
—
000551405BH
—
GA
05
—
000551405BI
—
GA
05
—
000551405BL
—
GA
05
—
000551405BM
—
GA
05
—
000551405BN
—
GA
05
—
000551405BO
—
GA
05
—
000551405D
—
GA
05
—
000551405F
—
GA
05
—
000551405J
—
GA
05
—
000639844T
—
GA
05
—
000693844B
—
GA
05
—
000693844C
—
GA
05
—
000693844N
—
GA
05
—
000693844O
—
GA
05
—
000693844Q
—
GA
05
—
000693844S
—
GA
05
—
000693844V
—
GA
05
—
000693844W
—
GA
05
—
000693844X
—
GA
Enumeration date
04/28/2006
Last updated
01/24/2021
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