McIntosh Trail Family Practice

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

029545 Issued in GA

Legal business name

MCINTOSH TRAIL FAMILY PRACTICE

Practice address

747 S Hill St
Griffin, GA 30224-4830

Phone

(770) 228-5407

Fax

(770) 227-1430

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

David A Van, M.D.

Title

Owner

Phone

(770) 228-5407

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carter Marie Whatley, PA-C

  • Medical Physician Assistant
  • Marietta, GA
  • NPI 1033476791
  NPD
• Jim Wayne Latimer, M.D.

  • Family Medicine Physician
  • McDonough, GA
  • NPI 1447318134
  NPD (past)

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262822400000",
    "number": "1023230422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "747 S HILL ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244830",
            "telephone_number": "770-228-5407",
            "fax_number": "770-227-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "747 S HILL ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244830",
            "telephone_number": "770-228-5407",
            "fax_number": "770-227-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCINTOSH TRAIL FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2010-01-07",
        "status": "A",
        "authorized_official_last_name": "VAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-228-5407",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "029545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• McIntosh Trail CSB
• McIntosh Trail CSB
• McIntosh Trail CSB (Pinewoods MH)
• McIntosh Trail CSB
• McIntosh Trail CSB (BHC Pharmacy)
• McIntosh Trail Management Services Inc
• Tracy Lashon McLean, LAPC
• David James McMurtry, PT, MPT
• MDG - Griffin Dental LLC (Doctor Laura Durham DDS)
• Medsurg Vision LLC

• Family Medicine Physician in Griffin, GA
• Providers in Griffin, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.