Provider Demographics
NPI:1295017325
Name:EASTER SEALS SOUTHERN GEORGIA INC.
Entity Type:Organization
Organization Name:EASTER SEALS SOUTHERN GEORGIA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:HATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-439-7061
Mailing Address - Street 1:1906 PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1575
Mailing Address - Country:US
Mailing Address - Phone:229-439-7061
Mailing Address - Fax:229-439-2824
Practice Address - Street 1:1906 PALMYRA RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1575
Practice Address - Country:US
Practice Address - Phone:229-439-7061
Practice Address - Fax:229-439-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047-R-0011251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000551405AEMedicaid
GA000551405AMMedicaid
GA000693844TMedicaid
GA000693844KMedicaid
GA000693844MMedicaid
GA000551405ABMedicaid
GA000551405ADMedicaid
GA000693844UMedicaid
GA000693844WMedicaid
GA000551405AIMedicaid
GA000551405AOMedicaid
GA000693844IMedicaid
GA000551405AKMedicaid
GA000551405AXMedicaid
GA000693844SMedicaid
GA000551405ANMedicaid
GA000693844JMedicaid
GA000693844VMedicaid
GA000551405ALMedicaid
GA000551405ATMedicaid
GA000551405AWMedicaid
GA000551405AUMedicaid
GA000551405AVMedicaid
GA000693844NMedicaid
GA000693844QMedicaid
GA000551405ACMedicaid
GA000693844LMedicaid