Provider Demographics
NPI:1730122482
Name:GA DEPARTMENT OF HUMAN RESOURCES
Entity Type:Organization
Organization Name:GA DEPARTMENT OF HUMAN RESOURCES
Other - Org Name:GEORGIA REGIONAL HOSPITAL AT ATLANTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATE
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:404-243-2121
Mailing Address - Street 1:P.O. BOX 370407
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3828
Mailing Address - Country:US
Mailing Address - Phone:404-212-5454
Mailing Address - Fax:404-243-2159
Practice Address - Street 1:3073 PANTHERSVILLE ROAD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3828
Practice Address - Country:US
Practice Address - Phone:404-243-2158
Practice Address - Fax:404-243-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-232283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00141061AMedicaid
114019GAMedicare Oscar/Certification
GA00141061AMedicaid