NPIMap

Organization Active NPI

Southern Health Corp of Ellijay

Doing business as North Georgia Family Practice

  • Rural Health Clinic/Center
  • Ellijay, GA
National Provider Identifier
1013248962
Registry record updated Jan 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
061435 Issued in GA
Legal business name
SOUTHERN HEALTH CORP OF ELLIJAY
Doing business as
North Georgia Family Practice
Practice address
60 Old Highway 5 South
Ellijay, GA 30540-5436
Phone
(706) 276-4741
Fax
(706) 276-4645
NPI assigned
Jan 15, 2010
Last updated
Jan 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Debbie Ann Self
Title
Cfo
Phone
(706) 276-4741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 061435 GA Primary

Addresses

Primary practice location

60 Old Highway 5 South
Ellijay, GA 30540-5436

Mailing address

PO Box 1019
Ellijay, GA 30540-0013
Phone (706) 276-4741

Other identifiers 1

IdentifierTypeStateIssuer
118527OtherGARURAL HEALTH CLINIC

Other names 1

  • North Georgia Family Practice Doing business as

National Provider Directory

National Provider Directory

Locations

822 Industrial Blvd
Ste B
Ellijay, GA 30540
Phone 70627647416450

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422403200000",
    "number": "1013248962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1019",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305400013",
            "telephone_number": "706-276-4741",
            "fax_number": "706-276-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 OLD HIGHWAY 5 SOUTH",
            "city": "ELLIJAY",
            "state": "GA",
            "postal_code": "305405436",
            "telephone_number": "706-276-4741",
            "fax_number": "706-276-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN HEALTH CORP OF ELLIJAY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-15",
        "last_updated": "2015-01-28",
        "status": "A",
        "authorized_official_last_name": "SELF",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "706-276-4741",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "GA",
            "license": "061435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH CLINIC",
            "identifier": "118527",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Georgia Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellijay, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.