Northeast Georgia Procedure Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

029-303 Issued in GA

Legal business name

NORTHEAST GEORGIA PROCEDURE CENTER LLC

Practice address

1620 Prince Ave
Suite B
Athens, GA 30606-6008

Phone

(706) 549-8114

Fax

(706) 549-0151

NPI assigned

Oct 3, 2006

Last updated

Feb 11, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dawnetta Janene Holladay, M.D.

Title

Ceo

Phone

(706) 549-8114

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 3

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.

• Jolaade Adebayo, M.D.

  • Interventional Pain Medicine Physician
  • Gainesville, GA
  • NPI 1316250434
  NPD (past)
• Reginald Strother, M.D.

  • Interventional Pain Medicine Physician
  • Athens, GA
  • NPI 1548241615
  NPD (past)
• Gary George Theofilis, DO, MBA, DABAM

  • Interventional Pain Medicine Physician
  • Cumming, GA
  • NPI 1558672014
  NPD (past)

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360540800000",
    "number": "1063507630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 80307",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306080307",
            "telephone_number": "706-549-8114",
            "fax_number": "706-549-0151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 PRINCE AVE",
            "address_2": "SUITE B",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066008",
            "telephone_number": "706-549-8114",
            "fax_number": "706-549-0151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA PROCEDURE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-02-11",
        "status": "A",
        "authorized_official_last_name": "HOLLADAY",
        "authorized_official_first_name": "DAWNETTA",
        "authorized_official_middle_name": "JANENE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-549-8114",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "029-303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "938358734A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northeast Georgia Anesthesiology LLC
• Northeast Georgia ENT-Head & Neck Surgery PC
• Northeast Georgia Gastroenterology Associates, PC
• Northeast Georgia House Calls LLC
• Northeast Georgia Nephrology & Hypertension Clinic, PC
• Northeast Georgia Regional Commission, Inc.
• Northeast Georgia Surgical Consultants PC
• Northeast Georgia Vision Care LLC (Jenkins Vision Care)
• Northeast Georgia Wellness Associates, LLC
• Northeast Health District (Children's Medical Services)

• Ambulatory Surgical Clinic/Center in Athens, GA
• Providers in Athens, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; 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.